Longitudinal challenges faced by perinatally-infected young people with HIV in Kenya during the COVID-19 pandemic

Understanding challenges experienced by adolescents and youth with HIV (AYWH) during COVID-19 can inform care during health crises.

From 2021 to 2023, bi-monthly in-person/phone surveys were administered to assess trends in psychological, physical, and socioeconomic challenges, and antiretroviral nonadherence, among Kenyan AYWH, alongside COVID-19 burden [caseloads and Oxford-Stringency-Index (OSI)]. Biannual viral loads (VLs) were described as virologic suppression (VL ≤ 40 copies/ml), virologic failure (VL > 40 copies/ml), and treatment failure (VL > 1000 copies/ml). Associations among caseloads/OSI, challenges, nonadherence, and treatment failure transitions (VL ≤ 1000 to >1000 copies/ml and vice versa) were evaluated using regression models, accounting for repeated-measures, age, gender, clinic, and between-visit days.

Among 441 participants (mean age 16.9 years, 49% female, mean time on antiretroviral therapy (ART) 11.9 years), 89% reported at enrollment challenges (48% psychological, 66% physical, 61% socioeconomic). Within-subject challenges, COVID-19 caseloads, and OSI scores varied over time alongside pandemic changes. During stringent periods and surges, physical challenges worsened [odds ratio (OR) = 1.04 per 100-cases increase/day, 95% confidence interval (CI) = 1.00-1.08]; psychological challenges were stable (OR = 1.02, CI = 0.98-1.06); socioeconomic challenges worsened during caseloads upticks (OR = 2.08, CI = 1.14-3.81). Higher challenges burden at enrollment was associated with slower reduction in challenges over time. Nonadherence (74% at enrollment) was associated with higher prior-visit challenges (psychological: OR = 1.37, CI = 1.24-1.51; physical: OR = 1.43, CI = 1.22-1.69; socioeconomic: OR = 1.27, CI = 1.11-1.46). Virologic and treatment failure occurred in 19% and 10%; suppression-to-failure transition was associated with worsening adherence (OR = 1.26, CI = 1.00-1.58).

Kenyan AYWH experienced substantial wellness challenges during COVID-19, possibly prompting poor adherence and viral outcomes. While stability of nonphysical challenges suggests COVID-19 adaptation, targeted interventions are warranted to support this vulnerable population during public health crises.