Sex differences in treatment outcomes among adolescents and young adults initiated on ART in Johannesburg, 2016-2017

Abstract

Background Despite the scale-up of antiretroviral therapy (ART) in South Africa, there is limited evidence on how this expansion has benefited male and female adolescents and young adults aged 15 to 24 years (AYAs) at the beginning of the universal test and treat (UTT) era in 2016. This study aims to evaluate sex-specific drivers of HIV treatment outcomes among AYAs 12 months after ART initiation at the start of the UTT era. Methodology A retrospective cohort study was conducted using routine patients’ data from the Therapy Edge database. Descriptive statistics were performed to compare baseline socio-demographic and clinical characteristics between male and female AYAs. Fisher’s exact test was conducted to assess the association between the baseline characteristics and the study outcome variables: viral load (VL) suppression and retention in care. A generalized mixed-effects model (GLMM) was used to identify sex-specific drivers of ART outcomes. Results The analysis revealed a higher VL suppression rate among females (74.5%) than males (60.0%). Along with an impressive retention to care rate of 99.1%, there was only one female participant who was deceased 12 months post-ART initiation. Baseline education level was identified as a predictor of VL suppression for both male (RR:1.43, CI:1.07-1.91, P=0.02) and female (RR:0.72, CI:0.61-0.86, p<0.01) AYAs. Additionally, the ART regimen was a predictor specifically for females (aRR:0.01, CI:0.10 - 0.20, p<0.01). Conclusion The results highlighted sex disparities in VL suppression among AYAs and demonstrated strong retention in care at the beginning of the UTT era. The findings indicate that baseline education level, and ART regimen should be considered for improved HIV treatment outcomes. Future research should explore sex-inclusive interventions to support sustained VL suppression AYAs.