Abstract:
HIV/AIDS remains a major global health challenge, with Sub-Saharan Africa carrying the highest burden. In Kenya, where adult prevalence is 4.3%, treatment interruption (IIT) continues to undermine antiretroviral therapy (ART) outcomes. This study aimed at applying machine learning (ML) to identify predictors of IIT and guide interventions in Machakos County, where prevalence is 3.3% and relies on manual appointment management of patients, physical tracing and phone tracing of patients. A retrospective cross-sectional study used secondary data from KenyaEMR covering 14,339 adults on ART between 2020 and 2024. Data preprocessing included cleaning, anonymization, imputation, encoding, LASSO feature selection, and SMOTE oversampling. Descriptive statistics and chi-square tests assessed associations, while Random Forest (RF), XGBoost, and Support Vector Machine (SVM) models were trained and validated to predict IIT. Overall, 910 patients (6%) experienced IIT. Risk was highest among adolescents and young adults (15–24 years), single individuals, urban residents, patients with viral load ≥1000 cps, those on ART <12 months, TB co-infected, and non-DTG regimen users. Poor adherence, unstable status, lack of phone ownership, and shorter refill durations also predicted IIT. Non-significant factors included sex, CD4 count, counseling, and clinic workload. Among models, RF achieved the best performance upon evaluation, (recall 0.97, precision 0.87, F1 0.92, AUROC 0.96, accuracy 0.91), outperforming XGBoost and SVM. IIT in Machakos County is shaped by demographic, clinical, socioeconomic, and health system factors. Random Forest showed the best predictive capacity, highlighting the value of ML for early identification of at-risk patients.Strategies should include DTG scale-up, early retention support, multi-month dispensing, and digital health interventions. Integrating predictive analytics into EMRs can strengthen HIV program outcomes.
