Factors associated with viral suppression among HIV-positive Kenyan gay and bisexual men who have sex with men

Figures & data

Figure 1. Participant study diagram of HIV-positive men who were enrolled in the Anza Mapema study and examined in this analysis. M6 month 6; M12 month 12.

Table 1. Distribution of sociodemographic and psychosocial characteristics and sexual risk behaviors among HIV-positive men at baseline (n = 63), and by viral suppression status (not suppressed: ≥1,000 copies/mL; suppressed: <1,000 copies/mL) at Month 6 (n = 52) and Month 12 (n = 59) follow-up visits.

Variable	Baseline	Month 6^a		Month 12^b
	n (%)	Not suppressed n (%)	Suppressed n (%)	Not suppressed n (%)	Suppressed n (%)
Sample	63 (100.0)	15 (28.8)	37 (71.2)	22 (37.3)	37 (62.7)
Age (years) (median/IQR)	27 (22–32)	–	–	–	–
Age (years)
18–24	24 (38.1)	–	–	–	–
≥25	39 (61.9)	–	–	–	–
Education (years)
0–8	21 (33.3)	–	–	–	–
9–12	26 (41.3)	–	–	–	–
≥13	16 (25.4)	–	–	–	–
Employment status
Less than full-time employed	24 (38.1)	6 (40.0)	13 (35.1)	14 (63.6)	14 (37.8)
Full-time employed	39 (61.9)	9 (60.0)	24 (64.9)	8 (36.4)	23 (62.2)
Perceived future financial status
Uncertain or very uncertain	18 (28.6)	8 (53.3)	13 (35.1)	8 (36.4)	13 (35.1)
Secure or very secure	45 (71.4)	7 (46.7)	24 (64.9)	14 (63.6)	24 (64.9)
Resided in Kisumu for less than 1 year
No	54 (90.0)	–	–	–	–
Yes	6 (10.0)	–	–	–	–
Marital status
Single	39 (61.9)	12 (80.0)	23 (63.9)	18 (81.8)	24 (64.9)
Married or living with female partner	9 (14.3)	1 (6.7)	6 (16.7)	1 (4.5)	6 (16.2)
Separated or divorced from female partner	15 (23.8)	2 (13.3)	7 (19.4)	3 (13.6)	7 (18.9)
Currently living with a male sexual partner
No	38 (60.3)	6 (60.0)	14 (82.4)	13 (59.1)	33 (89.2)
Yes	25 (39.7)	4 (40.0)	3 (17.6)	9 (40.9)	4 (10.8)
Harmful alcohol use (AUDIT ≥8)
No	29 (46.0)	12 (80.0)	19 (51.4)	15 (68.2)	22 (59.5)
Yes	34 (54.0)	3 (20.0)	18 (48.6)	7 (31.8)	15 (40.5)
Harmful substance use (DAST ≥3)
No	46 (73.0)	14 (93.3)	31 (83.8)	19 (86.4)	29 (78.4)
Yes	17 (27.0)	1 (6.7)	6 (16.2)	3 (13.6)	8 (21.6)
MOS social support (range: 0–100 scale)	45 (32–55)	59 (34–75)	55 (41–68)	56 (32–75)	57 (50–75)
Coping self-efficacy (range: 9–36)	–	20 (18–25)	26 (21–29)	19 (12–23)	26 (19–32)
Severe depressive symptoms (PHQ-9 ≥ 15)
No	51 (81.0)	15 (100.0)	35 (94.6)	22 (100.0)	35 (94.6)
Yes	12 (19.0)	0 (0.0)	2 (5.4)	0 (0.0)	2 (5.4)
Any sexual abuse during childhood (CECA)
No	24 (38.1)	–	–	–	–
Yes	39 (61.9)	–	–	–	–
Experienced physical abuse during childhood (CECA)
No	24 (38.1)	–	–	–	–
Yes	39 (61.9)	–	–	–	–
Ever refused any services
No	26 (47.3)	8 (57.1)	25 (73.5)	16 (76.2)	25 (73.5)
Yes	29 (52.7)	6 (42.9)	9 (26.5)	5 (23.8)	9 (26.5)
Experienced recent trauma due to same-sex behaviors (last three months) (USAID HPI)?
No	16 (31.4)	7 (53.8)	21 (65.6)	17 (81.0)	22 (64.7)
Yes	35 (68.6)	6 (46.2)	11 (34.4)	4 (19.0)	12 (35.3)
Ever had sex with a female partner
No	17 (27.0)	5 (33.3)	11 (29.7)	11 (50.0)	9 (24.3)
Yes	46 (73.0)	10 (66.7)	26 (70.3)	11 (50.0)	28 (75.7)
Gay or homosexual sexual identity
No	18 (28.6)	–	–	–	–
Yes	45 (71.4)	–	–	–	–
Transactional sex (participant received money, food, or housing) (last three months)
No	17 (27.0)	8 (53.3)	18 (48.6)	11 (50.0)	25 (67.6)
Yes	46 (73.0)	7 (46.7)	19 (51.4)	11 (50.0)	12 (32.4)
Always protected AI with a man (last 3 months)
No	47 (75.8)	6 (40.0)	20 (54.1)	13 (59.1)	19 (51.4)
Yes	15 (24.2)	9 (60.0)	17 (45.9)	9 (40.9)	18 (48.6)
Usual sexual position during AI with a male partner
Receptive or versatile	33 (54.1)	12 (85.7)	14 (38.9)	16 (72.7)	15 (41.7)
Insertive	28 (45.9)	2 (14.3)	22 (61.1)	6 (27.3)	21 (58.3)
Circumcision status
No	15 (23.8)	2 (13.3)	10 (27.0)	3 (13.6)	8 (21.6)
Yes	48 (76.2)	13 (86.7)	27 (73.0)	19 (86.4)	29 (78.4)

^aOf the 63 men included in this longitudinal analysis, 52 attended their month 6 visit and had a viral load measurement available; 10 attended their month 6 visit but did not have a viral load measurement available; and 1 missed his month 6 visit.

^bOf the 63 men included in this longitudinal analysis, 59 attended their month 12 visit and had a viral load measurement available; 3 attended their month 12 visit but did not have a viral load measurement available; and 1 missed his month 12 visit.

IQR interquartile range; AUDIT Alcohol Use Disorders Identification Test; DAST Drug Abuse Screening Test; MOS Medical Outcomes Study; PHQ-9 Personal Health Questionnaire-9; CECA Childhood Exposure to Care and Abuse; USAID HPI United States Agency for International Development Health Policy Initiative; AI anal intercourse.

Table 2. Distribution of clinical characteristics among HIV-positive men at baseline (n = 63), and by viral suppression status (not suppressed: ≥1,000 copies/mL; suppressed: <1,000 copies/mL) at Month 6 (n = 52) and Month 12 (n = 59) follow-up visits.

Variable	Baseline	Month 6^a		Month 12^b
	n (%)	Not suppressed n (%)	Suppressed n (%)	Not suppressed n (%)	Suppressed n (%)
Sample	63 (100.0)	15 (28.8)	37 (71.2)	22 (37.3)	37 (62.7)
Received treatment for any STI symptoms (last 3 months)
No	57 (90.5)	13 (86.7)	33 (89.2)	20 (90.9)	33 (89.2)
Yes	6 (9.5)	2 (13.3)	4 (10.8)	2 (9.1)	4 (10.8)
Any CT and/or NG infection?
No	45 (72.6)	15 (100.0)	36 (97.3)	17 (81.0)	29 (90.6)
Yes	17 (27.4)	0 (0.0)	1 (2.7)	4 (19.0)	3 (9.4)
HIV diagnosis status
Previously diagnosed and out-of-care	18 (28.6)	–	–	–	–
Newly diagnosed and out-of-care	45 (71.4)	–	–	–	–
WHO clinical stage
WHO clinical stage 1	49 (80.3)	14 (100.0)	29 (78.4)	19 (86.4)	30 (81.1)
WHO clinical stage 2, 3, or 4	12 (19.7)	0 (0.0)	8 (21.6)	3 (13.6)	7 (18.9)
CD4 count (median/IQR)	481 (334–651)	517 (306–685)	625 (453–782)	400 (337–733)	581 (433–793)
CD4 count
>200	59 (98.3)	14 (93.3)	33 (97.1)	21 (95.5)	35 (100.0)
<200	1 (1.7)	1 (6.7)	1 (2.9)	1 (4.5)	0 (0.0)
Viral load (copies/mL) (median/IQR)	16,798 (46–48,934)	29,456 (6,294–81,396)	20 (20–52)	21,848 (4,260–53,324)	20 (20–20)
Viral load (log10) (median/IQR)	4.22 (1.66–4.69)	4.47 (3.80–4.91)	1.30 (1.30–1.72)	4.33 (3.63–4.73)	1.30 (1.30–1.30)
Viral suppression at baseline
Not suppressed (≥1,000 copies/mL)	43 (69.4)	–	–	–	–
Suppressed (<1,000 copies/mL)	19 (30.6)	–	–	–	–
ART status
No	55 (87.3)	4 (26.7)	0 (0.0)	2 (9.1)	0 (0.0)
Yes	8 (12.7)	11 (73.3)	37 (100.0)	20 (90.9)	37 (100.0)

^aOf the 63 men included in this longitudinal analysis, 52 attended their month 6 visit and had a viral load measurement available; 10 attended their month 6 visit but did not have a viral load measurement available; and 1 missed his month 6 visit.

^bOf the 63 men included in this longitudinal analysis, 59 attended their month 12 visit and had a viral load measurement available; 4 attended their month 12 visit but did not have a viral load measurement available; and 1 missed his month 12 visit.

STI sexually transmitted infection; CT Chlamydia trachomatis; NG Neisseria gonorrhea; WHO World Health Organization; IQR interquartile range; ART antiretroviral therapy.

Table 3. Unadjusted analysis of baseline and time-dependent factors associated with viral suppression.

Variable	Baseline factors		Time-dependent factors
	OR (95% CI)	p value	OR (95% CI)	p value
Age (years)
18–24	0.28 (0.10–0.80)	0.02	–	–
≥25	1.00 (ref)		–
Education (years)
0–8	0.20 (0.05–0.82)	0.03	–	–
9–12	0.36 (0.09–1.36)	0.13	–	–
13 or more	1.00 (ref)		–
Employment
Less than full-time employed	0.29 (0.10–0.84)	0.02	0.58 (0.29–1.18)	0.13
Full-time employed	1.00 (ref)		1.00 (ref)
Perceived future financial status
Uncertain or very uncertain	1.12 (0.39–3.23)	0.84	1.11 (0.56–2.21)	0.76
Secure or very secure	1.00 (ref)		1.00 (ref)
Resided in Kisumu for less than 1 year
Yes	1.17 (0.19–7.02)	0.87	–	–
No	1.00 (ref)		–
Marital status
Married or living with female partner	1.93 (0.35–10.57)	0.45	2.16 (0.92–5.11)	0.08
Separated or divorced from female partner	0.84 (0.25–2.83)	0.78	1.62 (0.66–3.97)	0.29
Single	1.00 (ref)		1.00 (ref)
Currently living with a male sexual partner
No	3.25 (1.15–9.19)	0.03	1.39 (1.00–1.91)	0.05
Yes	1.00 (ref)		1.00 (ref)
Harmful alcohol use (AUDIT ≥ 8)
No	1.33 (0.48–3.66)	0.58	0.66 (0.40–1.10)	0.11
Yes	1.00 (ref)		1.00 (ref)
Harmful substance use (DAST ≥ 3)
Yes	1.30 (0.39–4.30)	0.67	0.67 (0.23–1.94)	0.46
No	1.00 (ref)		1.00 (ref)
MOS social support (continuous)	1.02 (0.99–1.05)	0.12	1.00 (0.99–1.01)	0.60
Coping self-efficacy (continuous)	–	–	1.08 (1.03–1.13)	<0.01
Severe depressive symptoms (PHQ-9 ≥ 15)
Yes	1.35 (0.36–4.99)	0.66	*	*
No	1.00 (ref)		*
Any sexual abuse during childhood (CECA)
Yes	1.32 (0.47–3.67)	0.60	–	–
No	1.00 (ref)		–
Any physical abuse during childhood (CECA)
Yes	1.10 (0.40–3.05)	0.85	–	–
No	1.00 (ref)		–
Ever refused any services
Yes	0.73 (0.25–2.14)	0.57	0.95 (0.59–1.55)	0.85
No	1.00 (ref)		1.00 (ref)
Experienced recent trauma due to same-sex behaviors (last three months) (USAID HPI)
Yes	0.93 (0.30–2.94)	0.91	0.99 (0.48–2.05)	0.99
No	1.00 (ref)		1.00 (ref)
Ever had sex with a female partner
Yes	1.57 (0.53–4.66)	0.42	1.50 (0.83–2.72)	0.18
No	1.00 (ref)		1.00 (ref)
Gay or homosexual sexual identity
No	1.23 (0.39–3.83)	0.72	–	–
Yes	1.00 (ref)		–
Transactional sex (for which the participant received money, food, or housing) (last 3 months)
Yes	0.30 (0.09–1.06)	0.06	0.83 (0.53–1.31)	0.43
No	1.00 (ref)		1.00 (ref)
Always protected AI with a man (last 3 months)
No	1.36 (0.44–4.20)	0.60	1.26 (0.65–2.46)	0.49
Yes	1.00 (ref)		1.00 (ref)
Usual sexual position during AI with a male partner
Receptive or versatile	0.25 (0.08–0.78)	0.02	0.35 (0.17–0.71)	<0.01
Insertive	1.00 (ref)		1.00 (ref)
Circumcision status
No	1.91 (0.53–6.85)	0.32	2.12 (0.66–6.86)	0.21
Yes	1.00 (ref)		1.00 (ref)
Received treatment for any STI symptoms (last 3 months)
Yes	6.17 (0.81–46.99)	0.08	0.50 (0.19–1.31)	0.16
No	1.00 (ref)		1.00 (ref)
Any CT and/or NG infection
Yes	1.84 (0.56–6.06)	0.31	0.32 (0.07–1.56)	0.16
No	1.00 (ref)		1.00 (ref)
HIV diagnosis status
Newly diagnosed and out-of-care	0.37 (0.11–1.31)	0.12	–	–
Previously diagnosed and out-of-care	1.00 (ref)		–
WHO clinical stage
WHO clinical stage 2, 3, or 4	2.90 (0.72–11.74)	0.14	–	–
WHO clinical stage 1	1.00 (ref)		–
CD4 count (cells/μL) (continuous)	1.00 (1.00–1.00)	0.26	–	–
CD4 count (cells/μL)
≥200	*	*	–	–
<200	*		–
Viral load (log10) at baseline (continuous)	0.56 (0.37–0.85)	0.01	–	–
Viral suppression at baseline
Not suppressed (≥1,000 copies/mL)	0.11 (0.02–0.58)	0.01	–	–
Suppressed (<1,000 copies/mL)	1.00 (ref)		–
Time
Month 12	–	–	0.84 (0.56–1.27)	0.41
Month 6	–		1.00 (ref)

*Bivariable model was not estimable.

OR odds ratio; CI confidence interval; IQR interquartile range; AUDIT Alcohol Use Disorders Identification Test; DAST Drug Abuse Screening Test; MOS Medical Outcome Study; PHQ-9 Personal Health Questionnaire-9; CECA Childhood Exposure to Care and Abuse; USAID HPI United States Agency for International Development Health Policy Initiative; AI anal intercourse; STI sexually transmitted infection; CT Chlamydia trachomatis; NG Neisseria gonorrhea; WHO World Health Organization.

Table 4. Adjusted^a analysis of factors associated with viral suppression.

Variable	Primary suppression outcome: <1,000 copies/mL vs. ≥1,000 copies/mL				Secondary suppression outcome: <200 copies/mL vs. ≥200 copies/mL
	Final model^b		Adjusted for baseline viral suppression^c		Final model^b		Adjusted for baseline viral suppression^c
	aOR (95% CI)	p value	aOR (95% CI)	p value	aOR (95% CI)	p value	aOR (95% CI)	p value
Employment status^d
Less than full-time employed	0.39 (0.13–1.16)	0.09	0.41 (0.12–1.46)	0.17	0.32 (0.10–0.95)	0.04	0.31 (0.09–1.09)	0.07
Full-time employed	1.00 (ref)		1.00 (ref)		1.00 (ref)		1.00 (ref)
Received treatment for any STI symptoms (last 3 months)^d
No	0.13 (0.01–1.57)	0.11	0.20 (0.02–2.31)	0.20	0.12 (0.01–1.62)	0.11	0.17 (0.02–2.02)	0.16
Yes	1.00 (ref)		1.00 (ref)		1.00 (ref)		1.00 (ref)
Usual sexual position during AI with a male partner^e
Receptive or versatile	0.20 (0.08–0.50)	<0.01	0.15 (0.05–0.40)	<0.01	0.22 (0.10–0.52)	<0.01	0.19 (0.08–0.48)	<0.01
Insertive	1.00 (ref)		1.00 (ref)		1.00 (ref)		1.00 (ref)
Coping self-efficacy (continuous)^e	1.10 (1.03–1.16)	<0.01	1.11 (1.03–1.19)	<0.01	1.09 (1.02–1.16)	0.01	1.10 (1.03–1.17)	0.01
Time
Month 12	0.71 (0.39–1.30)	0.27	0.70 (0.35–1.41)	0.32	0.83 (0.49–1.40)	0.48	0.85 (0.48–1.53)	0.59
Month 6	1.00 (ref)		1.00 (ref)		1.00 (ref)		1.00 (ref)
Viral suppression at baseline
Not suppressed (≥1,000 copies/mL)	–	–	0.27 (0.05–1.35)	0.11	–	–	0.16 (0.02–1.04)	0.06
Suppressed (<1,000 copies/mL)	–		1.00 (ref)		–		1.00 (ref)

^aPredictors are mutually adjusted for all other variables.

^bFinal multivariable model sample: 63 individuals contributed 108 observation points across two follow-up visits.

^cFinal multivariable model sample: 62 individuals contributed 106 observation points across two follow-up visits; one individual missing viral load at baseline.

^dTime-independent variable collected at baseline.

^eTime-dependent variable collected at two follow-up visits.

aOR adjusted odds ratio; CI confidence interval; STI Sexually transmitted infection; AI anal intercourse.