Psychosocial and Structural Factors Associated with Viral Non-Suppression among Adolescents and Young People Living with HIV Receiving Antiretroviral Therapy in Kinshasa, Democratic Republic of the Congo

Background: Viral non-suppression remains a major challenge among adolescents and young people living with HIV despite the expansion of access to antiretroviral therapy (ART). Evidence on the psychosocial and structural factors influencing virological outcomes remains limited in the Democratic Republic of the Congo. This study aimed to identify the psychosocial and structural factors associated with viral non-suppression among adolescents and young people living with HIV receiving care at Kalembelembe Pediatric Hospital in Kinshasa. Methods: A cross-sectional analytical study was conducted from January to December 2025 among adolescents and young people aged 10 - 24 years living with HIV and receiving ART at Kalembelembe Pediatric Hospital. A total of 397 participants who met the eligibility criteria, representing all eligible patients during the study period, were included. Data were collected from medical records and a standardized questionnaire. Viral non-suppression was defined as a viral load ≥ 1000 copies/mL, in accordance with World Health Organization recommendations. Factors associated with viral non-suppression were identified using multivariable logistic regression and are presented as adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs). Results: A total of 397 adolescents and young people were included. The mean age was 17.9 ± 3.8 years, and 57.4% were female. The prevalence of viral non-suppression was 33.5%. After adjustment, treatment interruptions (aOR = 2.47; 95% CI: 1.48 - 4.11; p < 0.001), missed clinic appointments (aOR = 1.96; 95% CI: 1.11 - 3.44; p = 0.020), low family support (aOR = 1.79; 95% CI: 1.06 - 3.01; p = 0.029), and depressive symptoms (PHQ-9 score ≥ 10) (aOR = 1.88; 95% CI: 1.10 - 3.19; p = 0.021) were independently associated with viral non-suppression. Conclusion: Viral non-suppression remains common among adolescents and young people living with HIV receiving ART in Kinshasa. Poor treatment adherence, low family support, and depressive symptoms were the main factors independently associated with viral non-suppression. Strengthening psychosocial support, routine screening for depressive symptoms, family-centered interventions, and strategies to improve retention in care may contribute to sustained viral suppression in this population.