INTRODUCTION: Chronic conditions are costly and major causes of death and disability. Addressing conditions earlier in adulthood can slow disease progression and improve well-being across the lifespan. We estimated, by life stage, 10-year trends among US adults in the prevalence of 1 or more chronic conditions, multiple chronic conditions (MCC; ≥2 conditions), and 12 selected chronic conditions. METHODS: We analyzed data from the 2013-2023 (odd years) Behavioral Risk Factor Surveillance System (N = 2,673,529). We estimated the prevalence of 1 or more conditions, MCC, and each of 12 conditions, by life stage: young (18-34 y), midlife (35-64 y), and older (≥65 y) adults. We used polynomial contrasts to analyze 10-year trends. RESULTS: In 2023, 76.4% (representing 194 million) of US adults reported 1 or more chronic conditions, including 59.5%, 78.4%, and 93.0% of young, midlife, and older adults, respectively. Moreover, 51.4% (representing 130 million) of US adults reported MCC, including 27.1%, 52.7%, and 78.8% of young, midlife, and older adults, respectively. Among young adults, from 2013 to 2023, prevalence increased significantly from 52.5% to 59.5% for 1 or more conditions and from 21.8% to 27.1% for MCC. CONCLUSION: Approximately 6 in 10 young, 8 in 10 midlife, and 9 in 10 older US adults report 1 or more chronic conditions. Trends in conditions worsened among young adults during 2013-2023. Recognizing the burden of chronic disease throughout life stages, especially earlier in life, practitioners and partners may consider prevention and management approaches critical for addressing costs, care, and health outcomes. Practitioners may also consider tailoring these approaches to unique roles, transitions, and challenges in different life stages.

BACKGROUND: In sub-Saharan Africa, mHealth interventions and phone-based data collection are increasingly popular but little is known about who can be reached by these programmes. We used national probability surveys to examine characteristics of youth (15-24 years) mobile phone owners in seven Southern African countries: Botswana, Eswatini, Lesotho, Malawi, Mozambique, Zambia, and Zimbabwe. METHODS: Population-based HIV Impact Assessment surveys are cross-sectional, nationally representative household-based surveys conducted between November 2019 and February 2022. Data were analysed using multivariable logistic regression. RESULTS: Eighty-four percent of youth in Eswatini, 83% in Botswana, 76% in Lesotho, 61% in Zimbabwe, 47% in Mozambique, 46% in Zambia and 32% in Malawi were mobile phone owners. In all countries, odds of phone ownership were higher amongst persons ages 20-24 (compared to 15-19) and those with secondary education or higher. In the three countries with ownership less than 50%, women had lower odds of owning a phone than men, and all wealth quintiles had higher odds of ownership than the lowest wealth quintile. CONCLUSIONS: Mobile phone ownership was consistently higher among certain demographic groups. Public health practitioners employing mobile phones for youth health programmes in Sub-Saharan Africa may not reach the general youth population.

PROBLEM/CONDITION: Autism spectrum disorder (ASD). PERIOD COVERED: 2022. DESCRIPTION OF SYSTEM: The Autism and Developmental Disabilities Monitoring Network is an active surveillance program that estimates prevalence and characteristics of ASD and monitors timing of ASD identification among children aged 4 and 8 years. In 2022, a total of 16 sites (located in Arizona, Arkansas, California, Georgia, Indiana, Maryland, Minnesota, Missouri, New Jersey, Pennsylvania, Puerto Rico, Tennessee, Texas [two sites: Austin and Laredo], Utah, and Wisconsin) conducted surveillance for ASD among children aged 4 and 8 years and suspected ASD among children aged 4 years. Surveillance included children who lived in the surveillance area at any time during 2022. Children were classified as having ASD if they ever received 1) an ASD diagnostic statement in a comprehensive developmental evaluation, 2) autism special education eligibility, or 3) an ASD International Classification of Diseases, Ninth Revision (ICD-9) code in the 299 range or International Classification of Diseases, Tenth Revision (ICD-10) code of F84.0, F84.3, F84.5, F84.8, or F84.9. Children aged 4 years were classified as having suspected ASD if they did not meet the case definition for ASD but had an evaluator's suspicion of ASD documented in a comprehensive developmental evaluation. RESULTS: Among children aged 8 years in 2022, ASD prevalence was 32.2 per 1,000 children (one in 31) across the 16 sites, ranging from 9.7 in Texas (Laredo) to 53.1 in California. The overall observed prevalence estimate was similar to estimates calculated using Bayesian hierarchical and random effects models. ASD was 3.4 times as prevalent among boys (49.2) than girls (14.3). Overall, ASD prevalence was lower among non-Hispanic White (White) children (27.7) than among Asian or Pacific Islander (A/PI) (38.2), American Indian or Alaska Native (AI/AN) (37.5), non-Hispanic Black or African American (Black) (36.6), Hispanic or Latino (Hispanic) (33.0), and multiracial children (31.9). No association was observed between ASD prevalence and neighborhood median household income (MHI) at 11 sites; higher ASD prevalence was associated with lower neighborhood MHI at five sites.Record abstraction was completed for 15 of the 16 sites for 8,613 children aged 8 years who met the ASD case definition. Of these 8,613 children, 68.4% had a documented diagnostic statement of ASD, 67.3% had a documented autism special education eligibility, and 68.9% had a documented ASD ICD-9 or ICD-10 code. All three elements of the ASD case definition were present for 34.6% of children aged 8 years with ASD.Among 5,292 (61.4% of 8,613) children aged 8 years with ASD with information on cognitive ability, 39.6% were classified as having an intellectual disability. Intellectual disability was present among 52.8% of Black, 50.0% of AI/AN, 43.9% of A/PI, 38.8% of Hispanic, 32.7% of White, and 31.2% of multiracial children with ASD. The median age of earliest known ASD diagnosis was 47 months and ranged from 36 months in California to 69.5 months in Texas (Laredo).Cumulative incidence of ASD diagnosis or eligibility by age 48 months was higher among children born in 2018 (aged 4 years in 2022) than children born in 2014 (aged 8 years in 2022) at 13 of the 15 sites that were able to abstract records. Overall cumulative incidence of ASD diagnosis or eligibility by age 48 months was 1.7 times as high among those born in 2018 compared with those born in 2014 and ranged from 1.4 times as high in Arizona and Georgia to 3.1 times as high in Puerto Rico. Among children aged 4 years, for every 10 children meeting the case definition of ASD, one child met the definition of suspected ASD.Children with ASD who were born in 2018 had more evaluations and identification during ages 0-4 years than children with ASD who were born in 2014 during the 0-4 years age window, with an interruption in the pattern in early 2020 coinciding with onset of the COVID-19 pandemic.Overall, 66.5% of children aged 8 years with ASD had a documented autism test. Use of autism tests varied widely across sites: 24.7% (New Jersey) to 93.5% (Puerto Rico) of children aged 8 years with ASD had a documented autism test in their records. The most common tests documented for children aged 8 years were the Autism Diagnostic Observation Schedule, Autism Spectrum Rating Scales, Childhood Autism Rating Scale, Gilliam Autism Rating Scale, and Social Responsiveness Scale. INTERPRETATION: Prevalence of ASD among children aged 8 years was higher in 2022 than previous years. ASD prevalence was higher among A/PI, Black, and Hispanic children aged 8 years than White children aged 8 years, continuing a pattern first observed in 2020. A/PI, Black, and Hispanic children aged 8 years with ASD were also more likely than White or multiracial children with ASD to have a co-occurring intellectual disability. Identification by age 48 months was higher among children born in 2018 compared with children born in 2014, suggesting increased early identification consistent with historical patterns. PUBLIC HEALTH ACTION: Increased identification of autism, particularly among very young children and previously underidentified groups, underscores the increased demand and ongoing need for enhanced planning to provide equitable diagnostic, treatment, and support services for all children with ASD. The substantial variability in ASD identification across sites suggests opportunities to identify and implement successful strategies and practices in communities to ensure all children with ASD reach their potential.

BACKGROUND: Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infection in children less than 5 years of age worldwide. In the United States, RSV commonly causes hospitalization in young children and is the leading cause of hospitalizations in infants. As new RSV immunizations become available, burden estimates are critical to guide the implementation of recommendations and quantify impact. METHODS: We estimated RSV-associated hospitalization rates at a large US pediatric medical center during an 8-year period using five approaches, namely, estimation directly from active and passive surveillance systems, both a crude and stratified capture-recapture analysis of data from both systems, and estimation based on discharge diagnosis codes. The stratified analysis was performed to ensure adherence with the capture-recapture methodology assumption that samples are independent and participants have an equal probability of being observed within each system. RESULTS: Overall, estimated RSV-associated hospitalization rates per 1000 children were 4.0 (2.5, 6.1) based on adjusted estimates from active surveillance, 1.7 (2.1, 4.4) from passive surveillance, 7.9 (5.7, 13.0) from crude capture-recapture analysis, 5.0 (3.8, 7.2) from the stratified capture-recapture, and 4.4 (4.0, 4.9) from discharge diagnosis codes. CONCLUSIONS: Each method has limitations and inherent biases that may impact the estimation of the burden of RSV. Capture-recapture analysis may be a useful tool to estimate the burden of RSV, but needs to be adjusted to account for possible violation of the assumptions of independence and equal probability of capture to ensure accurate approximation of disease burden and avoid over estimation.

We conducted formative interviews and design workshops to tailor evidence-based tools addressing informational needs around pre-exposure prophylaxis (PrEP) use among men who have sex with men (MSM) of color. Clients (n = 18) and providers (n = 19) were interviewed to explore needs and preferences for PrEP-related decision-making tools. Next, we developed an analysis matrix to design personas to tailor materials to real-world contexts. Existing PrEP educational materials were then revised using participant feedback elicited through the personas. We presented personas, findings, and revised materials to clients (n = 9) and providers (n = 9) in iterative design workshops and solicited further feedback. Revisions to materials for providers included tips for destigmatizing PrEP counseling and routine care, sexual practices, and structural barriers that YMSM of color often navigate. Our evidence-based approach has the potential to enhance shared decision-making and destigmatize HIV prevention counseling in our larger trial, thus promoting both PrEP uptake and persistence among YMSM of color. © 2025 National Communication Association.

Nirsevimab is a long-acting monoclonal antibody that protects infants and young children against severe respiratory syncytial virus (RSV) disease. Children are eligible for one 50 mg dose, one 100 mg dose, or two 100 mg doses of nirsevimab based on age, weight, time of year, maternal vaccination, and risk of severe disease. In winter 2023/2024, we developed a model to project the number of nirsevimab doses needed to immunize all eligible U.S. children during the 2024/2025 season. We grouped all births from March 2023 through March 2025 into weekly cohorts, partitioned those cohorts based on eligibility criteria, and computed eligibility for each partition. In the absence of maternal RSV vaccination, we estimated U.S. children would be eligible to receive 4.3 million nirsevimab doses in 2024/2025, of which 48% would be 100 mg doses. Projections of total eligibility can be used to inform production goals and avoid shortages of nirsevimab.

Inflammation and infections such as malaria affect concentrations of many micronutrient biomarkers, and hence estimates of nutritional status. We aimed to assess the relationship between malaria infection and micronutrient biomarker concentrations in pre-school children (PSC), school-age children (SAC) and women of reproductive age (WRA) in Malawi, and to examine the potential role of malaria immunity on the relationship between malaria and micronutrient biomarkers. Data from the 2015/2016 Malawi micronutrient survey were used. The associations between current or recent malaria infection, detected by rapid diagnostic test, and concentration of serum ferritin, soluble transferrin receptor (sTfR), zinc, serum folate, red blood cell (RBC) folate and vitamin B12, were estimated using multivariable linear regression. Factors related to malaria immunity including age, altitude and presence of hemoglobinopathies were examined as effect modifiers. Serum ferritin, sTfR and zinc were adjusted for inflammation using the BRINDA method. Malaria infection was associated with 68% (95% CI 51, 86), 28% (18,40) and 34% (13,45) greater inflammation-adjusted ferritin in PSC, SAC and WRA respectively (p<0.001 for each). In PSC, the positive association was stronger in younger children, in high altitude, and in children who were not carriers of the sickle cell trait. In PSC and SAC, sTfR was elevated (+ 25% (16, 29) and + 15% (9,22) respectively, p<0.001). Serum folate and RBC folate were elevated in WRA with malaria (+ 18% (3,35) and + 11% (1,23), p=0.01 and p=0.003 respectively). Malaria affects the interpretation of micronutrient biomarker concentrations and examining factors related to malaria immunity may be informative.

BACKGROUND: Since 2013, national trends in behavioral factors that increase STI risk among adolescent and young adult (A/YA) females have been mixed (e.g., fewer sex partners, lower condom use). We used data from a national sample of A/YA females to examine racial disparities in CT prevalence considering these trends. METHODS: Using 2011-March 2020 National Health and Nutrition Examination Survey data, we estimated the prevalence, unadjusted and adjusted prevalence ratios (APRs) of a positive CT urine test among sexually experienced non-Hispanic Black (Black), Hispanic, non-Hispanic Other race (NHO), and non-Hispanic White (White) A/YA females. Percentages were categorized by race/ethnicity, and each compared to the average of the other race/ethnic groups (e.g., Black vs. Hispanic, NHO and White). Covariates included age group, health insurance coverage, number of sex partners and condom use (both past year). RESULTS: Overall, the prevalence of CT infection among A/YA females was 5.8% (95% CI: 4.5%-7.3%). CT prevalence was higher among Black females (vs. Hispanic, NHO, and White) (11.7%; 95%CI: 8.7%-15.2%) and lower among White females (vs. Black, Hispanic, and NHO) (3.2%; 95%CI: 1.7%-5.5%). Compared with the average CT prevalence for Hispanic, NHO, and White females, Black females had a higher adjusted CT prevalence (APR: 2.48, 95%CI: 1.63-3.75). CONCLUSIONS: Nationally, CT prevalence was 2.5 times as high among Black A/YA females than the average prevalence for Hispanic, NHO, and White females. Inclusion of behavioral STI risk factors did not attenuate this association. Research incorporating sexual network-level factors associated with CT transmission may provide additional insights.

BACKGROUND: Child survival rates have improved globally, but neonatal mortality due to infections, such as group B Streptococcus (GBS), remains a significant concern. The global burden of GBS-related morbidity and mortality is substantial. However, data from low and middle-income countries are lacking. Vaccination during pregnancy could be a feasible strategy to address GBS-related disease burden. METHODS: We assessed maternal rectovaginal GBS colonization and neonatal disease rates in a prospective cohort of 6062 women-infant pairs. Surveillance for invasive infant disease occurred in parallel at 2 Kampala hospital sites. In a nested case-control study, we identified infants <90 days of age with invasive GBS disease (iGBS) (n = 24) and healthy infants born to mothers colonized with GBS (n = 72). We measured serotype-specific anticapsular immunoglobulin G (IgG) in cord blood/infant sera using a validated multiplex Luminex assay. RESULTS: We found a high incidence of iGBS (1.0 per 1000 live births) within the first 90 days of life across the surveillance sites, associated with a high case fatality rate (18.2%). Maternal GBS colonization prevalence was consistent with other studies in the region (14.7% [95% confidence interval, 13.7%-15.6%]). IgG geometric mean concentrations were lower in cases than controls for serotypes Ia (0.005 vs 0.12 µg/mL; P = .05) and III (0.011 vs 0.036 µg/mL; P = .07) and in an aggregate analysis of all serotypes (0.014 vs 0.05 µg/mL; P = .02). CONCLUSIONS: We found that GBS is an important cause of neonatal and young infant disease in Uganda and confirmed that maternally derived antibodies were lower in early-onset GBS cases than in healthy exposed controls.

Non-disclosure of known HIV-positive status is a barrier to ending HIV as a global health threat as it leads to biased measurements of HIV-treatment coverage indicators and inaccurate estimates of epidemic progress, resulting in wasted resources. Identifying and understanding factors driving non-disclosure among people living with HIV is necessary for encouraging engagement with HIV services and improving treatment coverage, resource allocation, and monitoring of HIV programs in high HIV-burden areas. This analysis assessed factors associated with non-disclosure among survey respondents who had antiretrovirals (ARVs) detected in blood specimens. HIV-positive blood specimens (n = 2,038) from the 2021 Mozambique Population-based HIV Impact Assessment were tested for the presence of ARVs. Weighted prevalence estimates of non-disclosure and select covariates are reported and factors associated with non-disclosure modeled via multivariate logistic regression. Among 1,358 respondents with ARVs detected, 14.1% did not self-report their HIV-positive status during the interview. Adjusting for socio-demographic and clinical factors, non-disclosure was more likely among younger participants aged 15-24 years (adjusted odds ratio [aOR]: 2.15, 95% Confidence Interval [CI] 1.16-4.01) and among those without knowledge of their recent sexual partner's HIV-status (aOR: 2.67, 95%CI: 1.38-5.15). Participants with an unsuppressed viral load were over six times (aOR: 6.27, 95%CI: 2.76-14.23) more likely to not disclose. Improving disclosure rates is vital to obtaining accurate HIV-treatment estimates and assessing epidemic progress. Initiatives prioritizing pre- and post-test counseling, stressing treatment literacy, emphasizing undetectable = untransmittable (U = U) campaigns, and encouraging programs that promote social support may encourage disclosure among individuals living with HIV.

Human metapneumovirus (hMPV) is an important cause of respiratory illness. However, information about hMPV incidence, patient characteristics, and symptoms outside hospital settings is limited. During June 2022-March 2024, participants aged 6 months-49 years who were enrolled in the CASCADIA community-based cohort study submitted weekly illness surveys and nasal swabs, and completed follow-up illness surveys. Swabs collected 0-3 days before reporting new or worsening symptoms were tested for hMPV and other respiratory viruses by multiplex polymerase chain reaction. Incidence was analyzed using an exponential survival model. Among 3,549 participants, 306 had symptomatic hMPV infection, representing an average of 7.5 cases per 100 persons per year (95% CI = 6.7-8.4). Incidence was highest during January-March (adjusted hazard ratio [aHR] = 4.3; 95% CI = 3.0-6.0) compared with October-December, and among those aged 2-4 years (aHR = 5.8; 95% CI = 3.8-9.0) compared with those aged ≥40 years. The most frequently reported symptoms were cough (80.4%) and nasal congestion (71.9%). Among 252 (82.4%) participants who completed a post-illness follow-up survey, 68 (27.0%) missed work, school, or child care facility attendance. Together, these findings indicate that hMPV is a common cause of respiratory illness during late winter to spring, particularly among young children, and frequently disrupts daily activities. Understanding hMPV epidemiology can guide surveillance definitions, clinical testing, and prioritization of prevention strategies.

BACKGROUND: Chlamydia and gonorrhea are among the most commonly reported sexually transmitted infections (STIs) in the U.S. Testing for chlamydia and gonorrhea infection can be conducted by anatomic site (site-specific). Monitoring testing volume and positivity by anatomic site is important. METHODS: Using a large national laboratory dataset, we assessed chlamydia and gonorrhea test volume and positivity by anatomical site in patients aged 15-60 years. RESULTS: The data contained 45 million tests each for chlamydia and gonorrhea for 2019-2023. Of chlamydia tests, 71.6% were for women. Among women, 0.4%, 1.5%, and 98.1% were performed on rectal, pharyngeal, and urogenital specimens; chlamydia positivity was 7.3%, 2.0%, and 4.3%, respectively. Among men, 10.5%, 13.7%, and 75.8% were performed on rectal, pharyngeal, and urogenital specimens; chlamydia positivity was 8.0%, 1.4%, and 6.3%, respectively. Among people aged 15-24 years, chlamydia positivity was 12.8% for rectal, 3.4% for pharyngeal, and 8.7% for urogenital among women, and 11.6%, 2.4%, and 12.2% among men, respectively. Gonorrhea testing volume overall and by age and sex was similar to that of chlamydia. Gonorrhea rectal, pharyngeal, and urogenital positivity was 3.2%, 2.4%, and 1.0% among women; 6.8%, 5.2%, and 3.3% among men; and 4.3%, 3.0%, and 1.6% among women aged 15-24 years, and 10.5%, 7.2%, and 4.6% among men aged 15-24 years, respectively. CONCLUSION: Although men accounted for <30% of overall chlamydia and gonorrhea testing, they accounted for a majority of extragenital testing. High rates of chlamydia and gonorrhea positivity by specimen type among many demographic groups, especially for extragenital specimens from men and young people, highlight the importance of STI prevention in the U.S.

BACKGROUND: The first dose of measles-rubella (MR) vaccine is routinely administered to infants aged 9 months as part of a standard two-dose schedule. However, during large measles outbreaks and in other settings of increased circulation or increased risk, WHO recommends administering a supplementary dose at age 6 months to protect young infants. We aimed to assess the immunogenicity and safety of a first dose of MR vaccine administered to infants aged 6 months and its effect on the immune response to the routine MR vaccine at age 9 months. METHODS: This open-label, randomised trial enrolled healthy infants aged 6 months in Matlab, Bangladesh, who had never received an MR vaccine dose and had no history of measles or rubella. Using a computer-generated block randomisation scheme, infants were randomly assigned (1:1) to receive either two doses of the MR vaccine, one at age 6 months and the second at age 9 months (two-dose group), or one dose at age 9 months (one-dose group). Baseline characteristics were recorded for all enrolled participants at age 6 months. Blood samples were drawn for antibody assays before each vaccination and at final follow up when infants were aged 11 months. The primary outcome was immunogenicity of a first MR vaccine in infants aged 6 months or 9 months and the immunogenicity of a second MR vaccine in infants aged 9 months who received their first MR vaccine at 6 months. Immunogenicity was measured as the proportion of infants who seroconverted in the 12 weeks after vaccination at age 6 months or the 8 weeks after vaccination at age 9 months. Seroconversion was defined as a 4-times increase in IgG concentrations relative to the pre-vaccination concentrations or achieving seroprotective antibody concentrations between study timepoints. The modified intention-to-treat analysis included all infants who received MR vaccines per group assignment and had antibody results at baseline, 9 months, and 11 months. All enrolled infants were included in the safety analysis of the immediate reactions (observed by study staff at the fixed-site clinic in the first 30 min after vaccination), adverse events within 48 h of vaccination among infants in the two-dose group receiving their first MR vaccine at age 6 months, and adverse events observed by study staff or parents at any time during the study. The trial is registered on ClinicalTrials.gov, NCT03071575, and is closed to enrolment. FINDINGS: Between March 9, 2017, and March 18, 2018, 620 infants were enrolled and randomly assigned to the two study groups (312 in the two-dose group and 308 in the one-dose group). Of the 301 infants vaccinated at 6 months, 282 seroconverted for measles (94%, 95% CI 90-96), and 283 seroconverted for rubella (94%, 91-96). By 11 months, after receiving a second dose at age 9 months, 297 (cumulative 99%, 95% CI 97-100) infants seroconverted for measles and 297 infants seroconverted for rubella (cumulative 99%, 96-100). Of the 292 infants vaccinated at 9 months only, 291 seroconverted for both antigens by age 11 months (100%, 95% CI 98-100). 123 adverse events were observed; 72 in the two-dose group and 51 in the one-dose group, with no differences in severity (p=0·78) or outcomes (p=0·71) by study group. 12 (17%) events in the two-dose group and seven (14%) in the one-dose group were severe; most events were mild, resolved without sequelae, and were unrelated to the MR vaccine. One death occurred in the one-dose group before the infant received the 9-month dose of the vaccine, and therefore was deemed to be unrelated to the MR vaccine. INTERPRETATION: The data presented support use of MR vaccine at 6 months to protect young infants during measles outbreaks and in settings with increased risk or high transmission. We recommend additional studies to evaluate longer-term immunity based on age at vaccination. FUNDING: US Centers for Disease Control and Prevention. TRANSLATIONS: For the French and Spanish translations of the abstract see Supplementary Materials section.

BACKGROUND: Adverse birth outcomes (ABOs) cause significant infant morbidity and mortality in resource-limited settings. Many of the maternal risk factors associated with ABOs can be prevented. We present the prevalence, trends, and risk factors of selected ABOs from a hospital-based birth defects surveillance program in Kampala, Uganda. METHODS: We analyzed data for all mothers with singleton deliveries collected from four urban hospitals between 2015 and 2022. Prevalence of preterm birth [PTB], low birth weight [LBW], small for gestational age [SGA], and stillbirth [SB] and maternal HIV seroprevalence were calculated among 222,427 births. SB was defined as infant born without life ≥ 28 weeks of gestation, LBW as term live birth weighing < 2500 g and PTB as live birth born < 37 weeks of gestation. Time trends of ABOs by maternal HIV status and age were computed using quasi-Poisson regression model and presented graphically. Risk factor associations were estimated using robust Poisson models adjusting for infant sex, hospital of delivery, and birth year. RESULTS: Prevalence of PTB, LBW, SGA, and SB were 14.8%, 4.3%, 17.8%, and 3.1%, respectively. Maternal HIV seroprevalence was 7.7%. Compared to mothers aged 25-34 years, young adolescents 10-18 years was associated with PTB (adjusted risk ratio [aRR]: 1.44, 95% confidence interval (CI): 1.38-1.50); LBW (1.65,1.51-1.81); and SGA (1.18; 1.12-1.24). HIV seropositivity was associated with PTB (1.18; 1.14-1.22), LBW (1.54; 1.43-1.65), and SGA (1.28; 1.23-1.33). Compared to starting ANC in the first trimester, no antenatal care (ANC) was associated with PTB (2.44; 2.33-2.56), LBW (1.80; 1.55-2.09), SGA (1.37; 1.27-1.49), and SB (3.73; 3.32-4.15) and late attendance with LBW (1.09; 1.02-1.16), SGA (1.26; 1.22-1.30), and SB (1.09; 1.02-1.17). Our findings also indicate a rising trend in PTB among adolescent and young women aged 10-24 years, and a declining trend in LBW and SGA over time (ptrend < 0.05 for all). CONCLUSIONS: Young maternal age, maternal HIV, and late or no ANC attendance were associated with ABO. Childbearing in the ages 25-34, preventing HIV in women, and supporting early and frequent ANC attendance are important in improving birth outcomes.

OBJECTIVE: The Diabetes in Children, Adolescents, and Young Adults (DiCAYA) network seeks to create a nationwide electronic health record (EHR)-based diabetes surveillance system. This study aimed to develop a DiCAYA-wide EHR-based computable phenotype (CP) to identify prevalent cases of diabetes. RESEARCH DESIGN AND METHODS: We conducted network-wide chart reviews of 2,134 youth (aged <18 years) and 2,466 young adults (aged 18 to <45 years) among people with possible diabetes. Within this population, we compared the performance of three alternative CPs, using diabetes diagnoses determined by chart review as the gold standard. CPs were evaluated based on their accuracy in identifying diabetes and its subtype. RESULTS: The final DiCAYA CP requires at least one diabetes diagnosis code from clinical encounters. Subsequently, diabetes type classification was based on the ratio of type 1 diabetes (T1D) or type 2 diabetes (T2D) diagnosis codes in the EHR. For both youth and young adults, the sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) in finding diabetes cases were >90%, except for the specificity and NPV in young adults, which were slightly lower at 83.8% and 80.6%, respectively. The final DiCAYA CP achieved >90% sensitivity, specificity, PPV, and NPV in classifying T1D, and demonstrated lower but robust performance in identifying T2D, consistently maintaining >80% across metrics. CONCLUSIONS: The DiCAYA CP effectively identifies overall diabetes and T1D in youth and young adults, though T2D misclassification in youth highlights areas for refinement. The simplicity of the DiCAYA CP enables broad deployment across diverse EHR systems for diabetes surveillance.

A fatal case of primary amebic meningoencephalitis (PAM), an infection caused by Naegleria fowleri, was diagnosed in Arkansas in a young child in September 2023. A public health investigation was completed, with epidemiologic, laboratory, and environmental data suggesting that a splash pad (an interactive water play venue that sprays or jets water on users and has little or no standing water) with inadequately disinfected water was the most likely site of the patient's N. fowleri exposure. This case is the third occurrence of splash pad-associated PAM reported in the United States; all three cases involved inadequately disinfected water. PAM should be considered in patients with acute meningoencephalitis and a history of recent possible exposure to fresh water, including treated recreational water (e.g., in splash pads or pools), via the nasal passages. Proper design, construction, operation, and management of splash pads can help prevent illnesses, including N. fowleri infections. Increased awareness, collaboration, and communication among clinicians, hospitals, laboratories, CDC, health departments, the aquatics sector, and the public can help support N. fowleri infection identification, treatment, prevention, and control efforts.

PURPOSE: The 2018 Kenya Population-based HIV Impact Assessment revealed gaps in HIV care among adolescents and young people living with HIV (AYPLHIV) aged 10-24 years, with only 70.6% aware of their status, of these, 93.1% on antiretroviral therapy (ART), and 79.2% of those on treatment had achieved viral load suppression (VLS). Operation Triple Zero (OTZ) aims to address these gaps by fostering intrinsic motivation in AYPLHIV to achieve good health outcomes, emphasizing zero missed appointments, zero missed medication, and zero viral load. We examine clinical outcomes of VLS, ART adherence, and retention among AYPLHIV aged 10-24 enrolled in OTZ from 2017 to 2021. METHODS: Data from 20 early adopter OTZ sites were analyzed for ART adherence, retention, viral load testing, and VLS. We compared demographic and clinical characteristics at enrollment and end line by sex, using Pearson's chi-square test for categorical variables, McNemar chi-square test, and Wilcoxon rank-sum for baseline versus end-line comparisons. RESULTS: Of 1,569 AYPLHIV enrolled in OTZ, 1,372 (87.4%) had complete records. The median age at OTZ enrollment was 12 years (interquartile range: 14-16). VLS improved from 72.7% to 88.5% (p < .001), and 96% of AYPLHIV were retained on ART. Among virally suppressed AYPLHIV at baseline (n = 958), 92.4% sustained VLS (91.9% females, 92.9% males), notably 100% among those on once-a-day dolutegravir or atazanavir. Re-suppression rate for viremic AYPLHIV at baseline (n = 360) was 78.3%. Satisfactory adherence correlated with higher re-suppression rates. DISCUSSION: OTZ implementation led to improved HIV treatment outcomes among AYPLHIV, contributing to sustained epidemic control efforts complementing other interventions.

INTRODUCTION: Varicella-zoster virus (VZV) testing is increasingly needed for assessing immunity and diagnosis in the varicella vaccination era. VZV-specific immunoglobulin G (IgG) is recommended when assessing immunity; real-time polymerase chain reaction (PCR) is recommended for varicella or herpes zoster diagnosis. The study objective was to describe VZV serologic and virologic testing in U.S. clinical practice. METHODS: Patients with serologic (IgG, IgM) or virologic (PCR, culture) VZV testing were identified in five administrative data sources (∼11-100 million enrollees; 2016-2023). Descriptive analyses were used to examine VZV testing frequency, patient characteristics, and rates by test type. The top 20 diagnostic codes associated with VZV test type were used as a proxy for reason for testing. RESULTS: Across data sources, the highest proportion of VZV testing was for IgG (43%-92%); most was in females (79%-82%) and those aged 20-39 years (62%-70%). Rates of serologic testing were 50-60/10,000 persons. Frequency of VZV virologic testing was considerably lower; PCR testing rates were ∼1/10,000 persons. Diagnostic codes associated with IgG or virologic testing were primarily categorized as routine care or acute illness, respectively. IgM testing was up to 11% of tests, despite not being recommended for screening or diagnostic purposes. CONCLUSIONS: VZV serologic testing rates were 50-60 times higher than PCR. Serologic testing was more common among females and young adults, likely due to screening. Most VZV testing appeared relevant to clinical management; however, inappropriate IgM testing was identified. Appropriate testing is important to guide clinical and public health management for varicella and herpes zoster.

BACKGROUND: To better establish the value of vaccination against influenza viruses, we estimated vaccine-averted influenza illnesses among young children and older adults in Chile, Guyana, and Paraguay. METHODS: We gathered country- and target population-specific data on monthly influenza hospitalizations, vaccine coverage, and vaccine effectiveness from surveillance records and immunization registries during 2013-2018. We applied a static compartmental model to estimate differences in the number influenza-associated respiratory disease events (symptomatic nonhospitalized illnesses, medically attended illnesses, hospitalizations) in the presence and absence of influenza vaccination programs. RESULTS: Between 2013 and 2018, vaccinating 68% of children aged 6-23 months in Chile averted an annual mean of 14 617 nonhospitalized, 9426 medically attended, and 328 hospitalized influenza illnesses; vaccinating 28% of children aged 6-23 months in Paraguay averted 1115 nonhospitalized, 719 medically attended, and 25 hospitalized influenza illnesses. Vaccinating 59% of older adults in Chile averted an annual mean of 83 429 nonhospitalized, 37 079 medically attended, and 1390 hospitalized influenza illnesses; vaccinating 36% of older adults in Paraguay averted an annual mean of 3932 nonhospitalized, 1748 medically attended, and 66 hospitalized influenza illnesses. In Guyana, a hypothetical campaign vaccinating 30% of children aged <5 years could have prevented an annual 1496 nonhospitalized, 971 medically attended, and 10 hospitalized influenza illnesses. Vaccinating 30% of adults aged ≥65 years could have prevented 568 nonhospitalized, 257 medically attended, and 10 hospitalized influenza illnesses. CONCLUSIONS: Influenza vaccination averted tens of thousands of illnesses and thousands of hospitalizations in Chile and Paraguay; influenza vaccination could have had a proportional benefit in Guyana.

BACKGROUND: Human parainfluenza viruses (PIV) are a major cause of acute respiratory infection (ARI) leading to hospitalization in young children. In order to quantify the burden of PIV hospitalizations and to evaluate the characteristics of children hospitalized with PIV by virus type, we used data from the New Vaccine Surveillance Network (NVSN), a multicenter, active, prospective population-based surveillance network, enrolling children hospitalized for ARI (defined as fever and/or respiratory symptoms) at 7 U.S. children's hospitals. METHODS: The study period included December 1, 2016 through March 31, 2020. Data captured included demographic characteristics, clinical presentation, underlying medical conditions, discharge diagnoses, and virus detection by RT-PCR. Linear and logistic regression were used to compare descriptive and clinical characteristics among children. Population-based PIV-associated hospitalization rates were calculated by age group and PIV-type. RESULTS: Of the 16,791 enrolled children with PIV virologic testing, 10,488 had only one respiratory virus detected, among whom 702 (7%) had positive testing for PIV without a co-detected virus (mean age [SD], 2.2 [3.2] years). Of these 702 children, 340 (48%) had underlying comorbidities, 139 (20%) had a history of prematurity, 121 (17%) were admitted to the ICU, and 23 (3%) required intubation. Overall, PIV hospitalization rates were highest in children aged 0-5 months (1.91 hospitalizations per 1,000 children per year [95% CI, 1.61-2.23], with PIV-3 contributing to the highest rates in that age group, followed by PIV-1 and PIV-4: 1.08 [0.84-1.21], 0.42 [0.28-0.58] and 0.25 [0.15-0.37] per 1,000 children per year, respectively. Seasonal distribution of PIV-associated hospitalizations varied by type. CONCLUSIONS: PIV infection was associated with a substantial number of ARI hospitalizations in children aged 0-5 months. Results suggest that future PIV prevention strategies in the US that focus on younger children and protection against PIV-3, PIV-1, and PIV-4 might have the greatest impact on reducing PIV hospitalization burden.

BACKGROUND: Despite the availability of highly effective HIV pre-exposure prophylaxis (PrEP), uptake and adherence to PrEP among young men who have sex with men (YMSM) remains low, limiting its impact on the prevention of HIV infection. Strategies that incorporate an array of prevention options and provide YMSM and their providers with tailored education and support tools, including tools to support shared decision-making, are needed. OBJECTIVE: The goals of the Centers for Disease Control and Prevention (CDC)-funded PrEP Choice study include the development and deployment of CDC guideline-consistent PrEP provider training and the implementation of evidence-based provider- and client-facing PrEP education and support tools. Under this initiative, the CDC funded 2 research projects, Florida State University (the Expanding PrEP in Communities of Color [EPICC] project), and Columbia University (the mChoice project). METHODS: Providers from both projects will complete the PrEP Choice online training, which was developed to educate providers on PrEP options and how to engage clients in open discussions around sexual health and PrEP options. EPICC project providers will also attend online tailored motivational interviewing (TMI) training sessions, and mChoice project providers will view a training video on cultural competency and humility in PrEP care. Following training, each project will enroll a cohort of 400 participants receiving care from study providers and follow them for 12-18 months. Participants will complete online surveys every 3 months and provide biomarkers to assess PrEP adherence. Electronic health record (EHR) data will be collected every 6 months to provide additional information on clinic attendance, PrEP prescriptions, and HIV/sexually transmitted infection (STI) testing. Each project will provide cohort participants with a unique digital health tool to support the PrEP choice and ongoing adherence. The study will assess the effectiveness of training and educational and support tools in practice and the critical factors associated with the successful uptake of and adherence to PrEP by participants. The study will also monitor patterns of PrEP use among YMSM, including types of PrEP and switching between types. RESULTS: Formative work to develop and prepare the tools for implementation was completed in 2023. The EPICC project began provider training in early 2024, and the mChoice project began in spring 2024. Cohort enrollment for both projects began after provider training began. CONCLUSIONS: Given the changing PrEP landscape, implementation of provider education and tools to maximize uptake and adherence is needed. By delivering culturally competent and interactive provider training on PrEP options, the study will help providers counsel and guide participants on the effective and safe use of PrEP. The digital health tools created will support participant adherence to help them optimize PrEP benefits. Through the cohort design, the PrEP Choice study will provide real-world data about PrEP use that will be critical for informing future guidelines and tools. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/64186.

INTRODUCTION: We aim to assess HPV vaccine administration among privately insured populations before and during the COVID-19 pandemic in the United States and stratify the assessments by demographic and geographic characteristics. METHODS: Using the Merative MarketScan Commercial Claims and Encounters Database, we estimated monthly and yearly HPV vaccine administration among people aged 9-26 from 2019 to 2022, measured as the proportion of the enrolled population who received ≥ 1 dose of HPV vaccine during that month or year, and their relative percent change from 2020 to 2022, compared to the same period in 2019, overall and stratified by age group, sex, and urbanicity. RESULTS: HPV vaccine administration in 2020, 2021, and 2022 was lower than in 2019 and continued to decline for all age groups. The relative percent change in rate in 2022 relative to 2019 was -6.0% among children, -38.3% among adolescents, and -42.5% among young adults. The patterns were similar across subgroups, with certain disparities in magnitude. By subpopulations, the highest percent declines in 2022 relative to 2019 in each age group were observed among children in rural areas (-13.5%), male adolescents (-39.8%), and young adults in rural areas (-46.0%). CONCLUSION: During the COVID-19 pandemic, HPV vaccine administration dropped substantially and had not exceeded the pre-pandemic levels by the end of 2022, with larger declines seen among male adolescents and young adults in rural areas. Our results highlight the need for continuing monitoring and targeted intervention strategies to improve HPV vaccine administration.

Eswatini has made substantial progress responding to its HIV epidemic and reducing violence against children. However, adolescent girls and young women with disabilities might be at increased risk for experiencing violence and for HIV infection, compared with those without disabilities. Data from the 2022 Eswatini Violence Against Children and Youth Survey were analyzed to compare HIV infection and violence-related measures by functional disability status (e.g., difficulties in performing functional activities such as seeing, walking, or communicating) among adolescent girls and young women. In 2022, in Eswatini, 14.0% of adolescent girls and young women aged 13-24 years had a reported functional disability. Compared with those without a functional disability, adolescent girls and young women with a functional disability had higher lifetime prevalences of experiencing sexual, physical, and emotional violence. They were also more likely to know where to seek help for experiences of violence. After adjusting for sociodemographic characteristics, HIV testing and infection status, HIV risk factors, sexual risk behaviors, and HIV treatment and prevention services did not differ by functional disability status. Prioritizing accessible, disability-inclusive prevention programs and services might help reduce experiences of violence among adolescent girls and young women with disabilities. Partnering with disability-led and disability-serving organizations and directly with adolescent girls and young women with disabilities to plan and implement programs and services that are disability-inclusive could help ensure that adolescent girls and young women with disabilities are aware of and can access these resources.

BACKGROUND: Household transmission of respiratory viruses may drive community spread. Few recent studies have examined household respiratory syncytial virus (RSV) transmission in the United States. METHODS: We conducted a prospective community-based cohort study from 1 June 2022 to 31 May 2023. Participants had blood samples collected and completed nasal swabs and surveys at least weekly, irrespective of symptoms. We tested serum for RSV antibody, nasal swabs by quantitative reverse transcription polymerase chain reaction (RT-qPCR), and performed whole genome sequencing. We evaluated secondary RSV transmission and associated risk factors based on a log-linear Poisson regression model. RESULTS: RSV was detected among 310 (10%) participants within 200 (20%) households. Most (94%) index cases were symptomatic. We identified 37 cases of potential secondary transmission within 14 days of a distinct index case (10%, 95% confidence interval [CI]: 7%, 14%); median age of index and secondary cases were 6 (interquartile range [IQR]: 3-10) and 35 (7-41) years, respectively, with 89% (24/27) of index cases aged 6 months to 12 years. Factors associated with increased risk of RSV transmission included index case viral detection ≥1 week and contact age ≤12 years. Of 120 sequenced specimens, the main lineages represented were A.d.5.2 (n = 37) and A.d.1 (n = 30). Sequenced viruses from households with ≥2 RSV infections were similar when occurring within ≤14 days (mean pairwise difference 4 [range 0-13], n = 17 households), compared to those >14 days (137 [37-236], n = 2). CONCLUSIONS: Most RSV household transmission occurs from infants and young children to adults. Viral genome sequencing demonstrated that multiple household infections within a 14-day period are likely due to within-household transmission.

Seroprevalence studies play an important role in estimating the number of children infected with SARS-CoV-2. We report SARS-CoV-2 seroprevalence in children seeking medical care for any reason at a free-standing pediatric hospital in Seattle, WA over a 2.5-year period and four distinct pandemic waves. We randomly selected residual serum samples from children and young adults seeking medical care as inpatients and outpatients at Seattle Children's Hospital between June 2020 and December 2022 to test for the presence of anti-nucleocapsid (N) antibodies. Samples were categorized into four distinct pandemic waves based on Washington State epidemiology: Wave 1 (June 2020-October 2020), Wave 2 (November 2020-June 2021), Wave 3 (July 2021-November 2021), and Wave 4 (December 2021-December 2022). Patient characteristics and COVID-19 vaccine status were obtained, and zip codes were used to ascertain the Social Vulnerability Index (SVI). Multivariable Poisson regression models with robust variance estimates were used to examine the relationship between patient characteristics and anti-N-positivity for each wave. Among 8,040 samples from 7,102 patients included in the analyses, seroprevalence rose from 2.4% (95% CI, 2.0%-3.1%) in Wave 1 to 25.5% (95% CI 23.3%-27.8%) in Wave 4 (following the Omicron surge). High SVI, Hispanic ethnicity, or use of government insurance was associated with increased anti-N positivity in most waves. We observed a steady increase in anti-N seroprevalence followed by a sharp increase after the Omicron surge in early 2022. Our data demonstrate the burden of COVID-19 on specific groups with health disparities within our region throughout the pandemic.IMPORTANCEOur results highlight the importance of seropositivity studies as essential tools to provide information on the incidence and prevalence of SARS-CoV-2 seropositivity. Our results also reinforce other reports demonstrating the inequitable burden of COVID-19 on groups with health disparities and that this inequitable burden continued to persist throughout the pandemic, even in a region with high adherence to COVID-19 mitigation efforts. It also highlights SVI's value in identifying communities that must be part of pandemic research, and public health and vaccination strategies.

People who inject drugs (PWID) account for the majority of hepatitis C virus (HCV) infections in the United States. The injection-equipment-sharing network likely plays an important role in shaping the dynamics of HCV transmission. Recognizing the emerging HCV epidemic in rural communities, we developed an agent-based network simulation model of HCV transmission via injection-equipment-sharing and used data on rural PWID networks to inform model parameterization and calibration. We then simulated an array of networks that varied key network properties to understand their impact on the magnitude and distribution of HCV incidence. The results show substantial heterogeneity in HCV acquisition risks across the network, summarized using the Ghyaini coefficient. In addition, although PWID with fewer injection partners had lower incidence, they collectively acquired more infections due to their larger population size. Higher prevalence, average number of partners, and homophily in HCV infection were associated with lower heterogeneity in infection risk across the network and higher overall incidence; other network properties including population size did not have a substantial impact. Our findings illustrate the heterogeneity of HCV transmission among PWID and suggest key network properties that could be measured, evaluated, or considered in the design of interventions for PWID in future studies.

BACKGROUND: There is paucity of information on the role of cytomegalovirus (CMV) infection as a cause of stillbirths or childhood deaths in low-and middle-income countries (LMICs). We investigated attribution of CMV-disease in the causal pathway to stillbirths and deaths in children <5 years of age in seven LMICs participating in the Child Health and Mortality Prevention Surveillance (CHAMPS) network. METHODS: We analyzed stillbirths and decedents enrolled between December 2016 and July 2023. Deaths were investigated using post-mortem minimally invasive tissue sampling with histopathology and molecular diagnostic investigations of tissues and body fluids, along with review of clinical records. Multi-disciplinary expert panels reviewed findings and reported on the causal pathway to death. RESULTS: CMV was detected in 19.5%(1140/5841) of all evaluated deaths, including 5.0% (111/2204), 6.2% (139/2229), 41.2% (107/260), 68.1%(323/474) and 68.2%(460/674) of stillbirths, neonates (deaths 0-<28 days postnatal), young infants (28-<90 days), older infants (90-<365 days) and children (12-<60 months), respectively. CMV-disease was attributed in the causal pathway to death in 0.9%(20/2204) of stillbirths, 0.8%(17/2229) of neonates, 13.1% (34/260) of young infants, 9.7%(46/474) of older infants and 3.3%(22/674) of children. Decedents with CMV-disease compared with those without CMV-disease in the causal pathway, were more likely to have severe microcephaly (38.2% vs. 21.1%; aOR 2.2, 95%CI: 1.3-3.6) and HIV-infected (36.9% vs. 6.2%; aOR: 10.9, 95%CI: 6.5-18.5). CONCLUSIONS: CMV-disease is an important contributor to deaths during infancy and childhood and is often associated with severe microcephaly and HIV-infection. Improving management of CMV in HIV-infected children and a vaccine to prevent CMV are needed interventions.

OBJECTIVES: After respiratory syncytial virus (RSV), human metapneumovirus (hMPV) was the second-ranked pathogen attributed to severe pneumonia in the PERCH study. We sought to characterize hMPV-positive cases in high-burden settings, which have limited data, by comparing with RSV-positive and other cases. METHODS: Children aged 1-59 months hospitalized with suspected severe pneumonia and age/season-matched community controls in seven African and Asian countries had nasopharyngeal/oropharyngeal swabs tested by multiplex PCR for 32 respiratory pathogens, among other clinical and lab assessments at admission. Odds ratios adjusted for age and site (adjusted OR [aOR]) were calculated using logistic regression. Aetiologic probability was estimated using Bayesian nested partial latent class analysis. Latent class analysis identified syndromic constellations of clinical characteristics. RESULTS: hMPV was detected more frequently among cases (267/3887, 6.9%) than controls (115/4976, 2.3%), among cases with pneumonia chest X-ray findings (8.5%) than without (5.5%), and among controls with respiratory tract illness (3.8%) than without (1.8%; all p ≤ 0.001). HMPV-positive cases were negatively associated with the detection of other viruses (aOR, 0.18), especially RSV (aOR, 0.11; all p < 0.0001), and positively associated with the detection of bacteria (aORs, 1.77; p 0.03). No single clinical syndrome distinguished hMPV-positive from other cases. Among hMPV-positive cases, 65.2% were aged <1 year and 27.5% had pneumonia danger signs; positive predictive value for hMPV aetiology was 74.5%; mortality was 3.9%, similar to RSV-positive (2.4%) and lower than that among other cases (9.6%). DISCUSSION: HMPV-associated severe paediatric pneumonia in high-burden settings was predominantly in young infants and clinically indistinguishable from RSV. HMPV-positives had low case fatality, similar to that in RSV-positives.

Young People Living with HIV (YPLHIV, 15-24 years) are an important demographic of Persons Living with HIV (PLHIV) globally and in Southern Africa. However, YPLHIV experience poor outcomes across the HIV diagnostic and treatment cascade due to multiple factors. We estimated the prevalence and determinants of HIV viral suppression in YPLHIV on antiretroviral therapy (ART) in selected Southern African countries. We used publicly available data from Malawi, Zimbabwe, Mozambique, Lesotho, and Eswatini collected during the Population-based HIV Impact Assessments (PHIAs) of 2020 to 2021. Weighted proportions, and 95% confidence intervals (CI) were computed to estimate the prevalence of viral suppression (< 1000c/ml) and bivariate and multivariate analyses were conducted to identify determinants of viral suppression. A total of 855 records of YPLHIV on ART were included in the analysis. The prevalence of viral suppression in YPLHIV on ART was 82.4% (95% CI: 76.7, 86.9). Residing in Mozambique and duration on ART were inversely associated with viral suppression; adjusted odds ratios (AORs) of 0.37 (95% CI: 0.14, 0.95), and 0.87 (95% CI: 0.80, 0.94), respectively. A negative result in the depression screen, being married/cohabitating, and ever switching an ART regimen were positively associated with viral suppression: AORs of 5.78 (95% CI: 2.21, 15.11), 3.72 (95% CI: 1.44, 9.63), and 3.44 (95% CI: 1.69, 7), respectively. YPLHIV had suboptimal viral suppression lower than the UNAIDS 95% targets and may benefit from further research and tailored interventions addressing modifiable factors associated with viral suppression such as depression.