Factors associated with drug resistance patterns among antiretroviral therapy-experienced adolescents in south rift valley, Kenya

Abstract

Even though antiretroviral (ART) has greatly improved survival of people living with HIV, resistance mutation is an emerging threat to scale up of ART globally. Adolescents have higher risk of drug resistance mutations (DRM). Factors associated with DRM in South Rift Valley remain unknown. The objective of study was to investigate factors associated with DRM among ART-experienced adolescents aged 10-19years enrolled in Nandi, Kericho, Bomet, and Narok counties. Specifically, study aimed to characterize HIV drug resistance patterns, assess biomedical; behavioral; and determine health systems factors associated with DRM. This cross-sectional cohort study comprised of 226 participants selected through simple random sampling using mixed method conducted between August-November 2024. Data on DRM was extracted using standardized tool and interpreted using Stanford HIVDR database. Questionnaires and interview guide used to collect data on biomedical, behavioral and health systems factors. Descriptive statistics, Chi-square test, and bivariate and multivariate logistic regression performed to examine association between variables and DRM. Quantitative data analyzed using SPSS Ver.27, with statistical significance set at p ≤ 0.05 while qualitative data used NOVO approach. Overall, 145 (64%) adolescents exhibited resistance. Mean age 16.3 years (SD = 2.7); 51.3% male and 65% orphans. Dual resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) and nucleoside reverse transcriptase inhibitors (NRTIs) occurred in 53%, while resistance to protease inhibitors (PIs) and integrase strand transfer inhibitors (INSTIs) was 9.3% and 7.1%, respectively. NNRTIs, resistance was highest to NVP (50.4%) and EFV (49.6%), commonly driven by K103N (23.9% and 28.8%). NRTI resistance included 3TC (40%, M184V 31%), AZT (20%, M184V 5.8%), ABC (26.3%, M184V 13.3%), and TDF (2.7%, M184V 1.8%). PI resistance featured ATV/r (V82A, L33F), DRV/r (L89V), and LPV/r (V82A). INSTI resistance included DTG, CAB, and RAL with S230R, G118R, R263K, and Y143R mutations. Bivariate analysis revealed factors associated with DRMs include duration on ART (p = 0.030), number of enhanced adherence counseling EAC sessions (p = 0.001), ART regimen type (p = 0.001), CD4 count (p = 0.030), caregiver occupation [p = 0.029], and orphan status [p = 0.049]. Multivariate logistic regression, ART duration, ART regimen, and EAC sessions associated with drug resistance. Longer ART duration, EAC sessions, and use of NNRTI-based regimens were associated with DRM. Thematic analysis suggests adherence among adolescents is shaped by both individual motivation and by social, family, and systemic factors. Participants suggested that empowering caregivers through education on ART adherence, HIV literacy, and adolescent development could foster a more supportive home environment