Age-related disparities in viral suppression among older individuals living with HIV in rural Uganda

BACKGROUND: The number of people living with HIV (PLWH) in sub-Saharan Africa who are over 50 years old is increasing rapidly, and expected to triple by 2040. Yet, how older PLWH sustain access to care and viral suppression is not well known. We examined the prevalence and correlates of viral suppression in a cohort of older PLWH in Uganda. METHODS: We analyzed data from the Quality of Life and Aging with HIV in rural Uganda study, which follows PLWH over 50 years old who are in care at public HIV clinics in Uganda. Our outcome of interest was viral suppression, defined as HIV-1 RNA viral load less than 200 copies/mL. We estimated the prevalence of viral suppression and fitted multivariable log binomial regression models to identify correlates of viral suppression. RESULTS: The mean cohort age was 59.7 years (standard deviation [SD] 6) and participants had been taking HIV therapy for a mean of 13.3 years (SD 3). Viral suppression was relatively high overall (87%, 240/277). In multivariable models, people aged ≥ 60 years were less likely to be virally suppressed than those aged 50-59 years (78% vs. 93%, adjusted prevalence ratio [APR] 0.85, 95% CI: 0.76, 0.93, P = 0.001). By contrast, having one or more comorbidities was positively associated with viral suppression (APR 1.10, 95% CI: 1.01, 1.18, P = 0.021). CONCLUSION: We found a decreased prevalence of viral suppression among PLWH aged ≥ 60 years atleast in Uganda. Public health interventions that address the adherence support needs of older individuals should be evaluated and, if successful, incorporated into HIV care services, given the significant number of older people living with HIV in the region.