Background: Viral suppression is key indicator of antiretroviral treatment (ART) success. In Kenya adolescents and young people (AYP) living with HIV have low-level viral load suppression of 52%. Data on viral suppression outcomes and its associated factors among AYP on ART in Kenya’s rural setting is limited. We described viral suppression outcomes among AYP on ART in rural Gatanga sub-county.

Methods: We conducted retrospective cross-sectional study among AYP aged 10–24 years on ART as of April 2022. We defined cases as those with viral suppression of <1,000 viral copies/ml of blood. Data were abstracted from Electronic Medical Record system, cleaned, coded and analyzed. Continuous variables were described using means while categorical variables were described using frequencies and proportions. We calculated prevalence odds ratios (POR) at 95% Confidence Level to determine association between independent variables and outcome of interest (viral suppression).

Results: We abstracted 195 records of AYP on ART, their mean age was 16.7± SD 4.3 years, females were 61%. Overall, virological suppression was 90% with suppression rates of 88% in those aged 10–14 years and 86% for those aged 20–24 years. Those who had viral load results within the previous 1 year were 39%. Being male (POR: 2.06, 95% CI: 0.81-5.2), on second-line ART regimens (POR 5.47, 95% CI: 1.98–15.08) relative to 1st line and Protease Inhibitors & Non-Nucleoside Reverse Transcriptase Inhibitors based regimens (POR: 3.14, 95% CI: 1.08–9.06) relative to Dolutegravir based ART regimens were associated with non-suppression.

Conclusions: Viral load suppression was suboptimal among AYP on ART. Being on Second-line ART and use of PI & NRTI-based ART regimens were risk factors for viral non-suppression. Timely Viral-load testing would be critical for their optimal management and enhanced adherence. Targeted messaging to AYP like psychosocial support groups within the age bands could be used to reach this group.