Correlates of viral non-suppression among adolescents transitioning from paediatric to adult HIV care in Zambia’s Copperbelt Province: a 2009 cohort analysis

Adolescents living with HIV are at heightened risk of disengagement and poor treatment outcomes during the transition from paediatric to adult care. Identifying factors linked to unsuppressed viral load in this population is essential for guiding effective support. This study aimed to identify demographic, clinical, and psychosocial correlates of viral non-suppression among adolescents transitioning to adult HIV care in Zambia’s Copperbelt Province. A retrospective cohort analysis was conducted using routine clinical data. Logistic regression analysis identified independent correlates of viral non-suppression, defined as a viral load ≥1000 copies/mL. Approximately 42% of the cohort had a non-suppressed viral load at their last measurement. Key independent correlates included male gender (adjusted odds ratio 1.8), orphan status, suboptimal clinic attendance in the year prior to transition, and reported stigma. Age and duration on antiretroviral therapy showed no significant association. Viral non-suppression is highly prevalent among transitioning adolescents in this setting. The findings highlight a confluence of social vulnerability and healthcare engagement issues that compromise treatment success during this critical period. Transition programmes require strengthening with targeted psychosocial support, particularly for orphaned adolescents and males. Interventions must prioritise improving clinic attendance and addressing HIV-related stigma in the year preceding transition to adult care. adolescent health, HIV, viral load suppression, healthcare transition, Zambia, paediatric HIV, antiretroviral therapy This research provides evidence on specific risk factors for treatment failure during care transition, informing the development of more effective adolescent-centred HIV services in sub-Saharan Africa.