Age-Related Inequalities in Viral Load Suppression among People Living with HIV in Ghana: Trends and Equity Analysis, 2018–2023

Background: Viral load suppression (VLS) is a key indicator of effective HIV treatment and a cornerstone of achieving the UNAIDS 95-95-95 targets. While Ghana has made progress in expanding antiretroviral therapy (ART) coverage, concerns persist regarding age-related disparities in treatment outcomes, particularly among children. This study examines trends in VLS inequality between children and adults in Ghana from 2018 to 2023 using standardized equity metrics. Methods: This time trend analysis used age-disaggregated data from the WHO Equity Database. VLS was defined as the proportion of people living with HIV (PLHIV) with viral load ≤ 1,000 copies/mL. Data were grouped into children (< 15 years) and adults (≥ 15 years). Four equity measures were applied using the WHO Health Equity Assessment Toolkit (HEAT): absolute difference (D), prevalence ratio (R), population attributable risk (PAR), and population attributable fraction (PAF). Annual trends were analyzed to assess inequality over time. Results: National VLS improved from 22% in 2018 to 40% in 2023. However, adults consistently exhibited higher suppression rates than children. The absolute difference (D) between adults and children widened from 11 to 14 percentage points. In contrast, the prevalence ratio (R) declined from 1.92 to 1.52, suggesting relative improvements in VLS among children. The population attributable risk (PAR) remained stable at 1.0 percentage point, while the population attributable fraction (PAF) declined from 4.55–2.50%, reflecting a modest reduction in the proportion of national VLS lost due to age-related inequality. Conclusion: Persistent age-based disparities in VLS remain a challenge in Ghana’s HIV response. Despite recent improvements, children continue to be disproportionately affected. Targeted pediatric interventions and routine application of equity metrics are essential to achieving equitable HIV control outcomes.