Achieving Antiretroviral Therapy Uptake and Viral Suppression Among Children and Adolescents Living With HIV in the UNAIDS 90-90-90 Era Across Six Countries in Eastern and Southern Africa—Lessons From the BIPAI Network

Abstract

Background: Although achievements have been made globally since the UNAIDS 90-90-90 targets were announced, paediatric data remain sparse. We describe achievements toward antiretroviral therapy (ART) uptake and viral load (VL) suppression, existing gaps, and potential best practices among children and adolescents living with HIV (CALHIV) across 6 Eastern and Southern African countries.

Virologic Outcomes and ARV Switch Profiles 2 Years After National Rollout of Dolutegravir to Children Less Than 15 Years in Southern Mozambique

“…26 Among children in 6 SSA countries, VLS after 12 months on DTG was 93%, though the cohort had a much higher VLS rate of 95% before DTG introduction than our cohort. 16 We are likely to have seen higher VLS among children on DTG in our study if we had higher suppression rates from the pre-DTG period as in these other studies. Nonetheless, the proportion of children virally unsuppressed decreased by about 21 percentage points following the DTG switch.…”

“…This supports other evidence that found no difference among children virally unsuppressed before the single-drug switch to DTG when comparing small numbers on ABC, AZT or TDF-based backbones. 16 While long-term data from adults in the Nucleosides and Darunavir/Dolutegravir in Africa trial suggests the superiority of TDF compared with AZT-based backbone in terms of viral rebound and drug resistance, there were no children in our study with VL data at ≥6 months maintaining an AZT backbone or switching from TDF to AZT to inform a comparison. 32 While we conducted extensive quality control, data accuracy and completeness could have been compromised due to the use of clinic records.…”

“…14 While real-world data from SSA are still limited, there is emerging evidence of DTG effectiveness in these settings, with VLS rates of about 90% or above among children and adolescents. 15,16 Aligned with WHO recommendations, new pediatric ART guideline implementation began in September 2019 in Mozambique. Children on first-line ART were to transition to abacavir [ABC]/lamivudine [3TC]+DTG 50 mg (weight ≥20-29.9 kg) or tenofovir disoproxil fumarate [TDF]/3TC+DTG 50 mg (weight ≥30 kg).…”

“…14 While real-world data from SSA are still limited, there is emerging evidence of DTG effectiveness in these settings, with VLS rates of about 90% or above among children and adolescents. 15,16…”

HIV Viral Load Scale-up Among Children and Adolescents: Trends in Viral Load Suppression, Sample Type and Processing in 7 PEPFAR Countries, 2015–2018

“…3 For instance, achieving viral suppression (VLS) among children and adolescents <20 years living with HIV (CALHIV) has been challenging. 4 To better understand the poorer VL outcomes in CALHIV, Centers for Disease Control and Prevention (CDC) supported 7 PEPFAR-supported countries with a high burden of HIV among children and adolescents to collect data from their respective Laboratory Information Management Systems (LIMS) to describe trends in pediatric and adolescent VL testing.…”