AIDS and Behavior

, Volume 23, Issue 2, pp 513–522 | Cite as

Virological Non-suppression and Its Correlates Among Adolescents and Young People Living with HIV in Southern Malawi

  • Eric UmarEmail author
  • Judith A. Levy
  • Robert C. Bailey
  • Geri Donenberg
  • Ronald C. Hershow
  • Mary Ellen Mackesy-Amiti
Original Paper


We examined virological non-suppression (VLN) among youth ages 13–24 years receiving HIV treatment in public health facilities in six southern Malawi districts. We also tested three ART adherence measures to determine how well each identified VLN: pill counts, a Likert scale item, and a visual analogue scale. VLN was defined as HIV RNA > 1000 copies/ml. Of the 209 youth, 81 (39%) were virally non-suppressed. Male gender and stigma were independently associated with VLN; social support and self-efficacy were independently protective. Pill count had the highest positive predictive value (66.3%). Using a pill count cut-off of < 80% nonadherence, 36 (17%) of the youth were non-adherent. Of the adherent, 120 (69%) were viral suppressed. Results indicate the need to address HIV-related stigma and to bolster social support and selfefficacy in order to enhance viral suppression. In the absence of viral load testing, pill count appears the most accurate means to assess VLN.


HIV/AIDS Antiretroviral therapy Adolescent Virological non-suppression Adherence 



We thank the study’s participants for their time and participation. We also are grateful to the health providers at each district hospital for their help in recruiting our study sample. Support for the study was provided through a dissertation award to the senior author by the UIC AIDS International Training and Research Program through funding from the John E. Fogarty International Center of the National Institutes of Health (D43 TW001419).


This study was funded by Fogarty AIDS International Training and Research Program (AITRP) (Grant No.: D43 TW001419).

Compliance with Ethical Standards

Conflict of interest

All authors declare no conflict of interest.

Ethical Approval

Study procedures, instruments, and all materials were reviewed and approved by the Institutional Review Boards of the University of Illinois at Chicago and the University of Malawi’s College of Medicine Research and Ethics Committee. All procedures involving human participants were conducted in accord with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Voluntary informed consent was obtained from those participants who were 18-24 years of age and both assent and parental permission from those ages 13-17.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Health Systems and PolicyUniversity of MalawiBlantyreMalawi
  2. 2.University of Malawi, College of MedicineBlantyre 3Malawi
  3. 3.Department of Health Policy and AdministrationUniversity of Illinois at ChicagoChicagoUSA
  4. 4.Department of Epidemiology and BiostaticsUniversity of Illinois at ChicagoChicagoUSA

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