Factors associated with <scp>HIV</scp> viral suppression among children and adults receiving antiretroviral therapy in Malawi in 2021: Evidence from the Laboratory Management Information System

OBJECTIVE To describe the prevalence of HIV viral suppression and assess the factors associated with HIV viral suppression among persons receiving ART in Malawi in 2021. METHODS Implementation study using routinely collected patient-level HIV RNA-PCR test result data extracted from the national Laboratory Management Information System (LIMS) database managed by the Department of HIV/AIDS in 2021. We calculated frequencies, proportions and odds ratios (OR) of HIV viral suppression with their associated 95% confidence intervals (95%CI). We performed a random-effects logistic regression to determine the risk factors associated with HIV viral suppression amongst ART patients, controlling for the spatial autocorrelation between districts and adjusting for other variables. RESULTS We evaluated 515,797 adults and children receiving ART and having a viral load test in 2021. Of these, 92.8% had HIV viral suppression. ART patients living in urban areas had lower likelihood of HIV viral suppression than those living in rural areas (adjusted OR [aOR]=0.95, 95%CI: 0.92-0.99, P=0.01). There was an increasing trend in HIV viral suppression with increasing ART duration. Routine VL monitoring samples were 39% more likely to have suppressed VL values than confirmatory HIV VL monitoring samples (aOR=1.39; 95%CI:1.34-1.43, P