Retention to Care and Viral Load Suppression: Insights from Young People Receiving HIV Treatment at Mpilo Centre of Excellence in Bulawayo, Zimbabwe.

Background: Retention to care and viral load suppression are essential components for effective HIV management, particularly among adolescents and young adults aged 15-24 years, who remain vulnerable to treatment challenges. This study aimed to assess factors associated with poor retention in care and viral load suppression among young people receiving antiretroviral therapy (ART) at Mpilo Centre of Excellence (MCoE) in Bulawayo, Zimbabwe, with the objective to guide youth-friendly interventions and improve health outcomes. Methods: A mixed methods cross-sectional study was conducted involving 110 HIV-positive youths aged 15-24 years on ART, recruited through systematic sampling and surveyed between November and December 2024. Data was collected using structured questionnaires, focus group discussions, in-depth interviews, and key informant interviews. Quantitative data were analyzed using descriptive statistics and logistic regression models to identify factors linked to viral load suppression, while qualitative data underwent thematic analysis. Results: Viral load suppression was achieved by 68.19% of participants, who met the viral suppression criterion of <50 copies/ml. Analysis identified several significant predictors via multivariable logistic regression. Younger adolescents (15-19 years) had lower odds of achieving suppression compared to older youths (20-24 years) (Adjusted Odds Ratio [AOR]: 0.81; 95% Confidence Interval [CI]: 0.67-0.97; p=0.041), while female participants demonstrated higher suppression rates than males (AOR: 0.43; 95% CI: 0.21-0.96; p=0.032). Absence of adherence challenges to ART emerged as a strong predictor of suppression (AOR: 0.12; 95% CI: 0.03-0.72; p=0.018), and perceived lack of clinical staff support was associated with a threefold higher risk of unsuppressed viral load (AOR: 3.01; 95% CI: 1.34-7.69; p=0.046). Lower treatment self-efficacy negatively impacted suppression odds (AOR: 2.65; 95% CI: 1.11-7.83; p=0.046), and lack of friend support for clinic visits reduced the likelihood of suppression (AOR: 0.31; 95% CI: 0.09-0.89; p=0.001). Qualitative findings confirmed that persistent barriers--including stigma, limited family support, economic hardship, school and work commitments--compromised both retention and adherence among adolescents and young adults. Conclusion: Younger age, male sex, ART adherence challenges, lack of clinical staff support, and lower treatment self-efficacy were significantly associated with poor viral suppression among 15-24-year-olds at Mpilo Centre of Excellence. These findings underscore the need for tailored adolescent- and youth-friendly services, enhanced adherence support, and improved treatment literacy to strengthen retention in care and viral suppression. Addressing these factors is critical for advancing progress towards UNAIDS 95-95-95 targets and reducing HIV transmission among Zimbabwean youth.