Viral suppression among children and their caregivers living with HIV in western Kenya

Abstract

Introduction Despite the central role of caregivers in managing HIV treatment for children living with HIV , viral suppression within caregiver–child dyads in which both members are living with HIV is not well described. Methods We conducted a retrospective analysis of children living with HIV <15 years of age and their caregivers living with HIV attending HIV clinics affiliated with the Academic Model Providing Access to Healthcare ( AMPATH ) in Kenya between 2015 and 2017. To be included in the analysis, children and caregivers must have had ≥1 viral load ( VL ) during the study period while receiving antiretroviral therapy ( ART ) for ≥6 months, and the date of the caregiver's VL must have occurred ±90 days from the date of the child's VL . The characteristics of children, caregivers and dyads were descriptively summarized. Multivariable logistic regression was used to estimate the odds of viral non‐suppression (≥ 1000 copies/ mL ) in children, adjusting for caregiver and child characteristics. Results Of 7667 children who received care at AMPATH during the study period, 1698 were linked to a caregiver living with HIV and included as caregiver–child dyads. For caregivers, 94% were mothers, median age at ART initiation 32.8 years, median CD 4 count at ART initiation 164 cells/mm 3 and 23% were not virally suppressed. For children, 52% were female, median age at ART initiation 4.2 years, median CD 4 values at ART initiation were 15% (age < 5 years) and 396 cells/mm 3 (age ≥ 5 years), and 38% were not virally suppressed. In the multivariable model, children were found more likely to not be virally suppressed if their caregivers were not suppressed compared to children with suppressed caregivers ( aOR = 2.40, 95% CI : 1.86 to 3.10). Other characteristics associated with child viral non‐suppression included caregiver ART regimen change prior to the VL , caregiver receipt of a non‐ NNRTI ‐based regimen at the time of the VL , younger child age at ART initiation and child tuberculosis treatment at the time of the VL . Conclusions Children were at higher risk of viral non‐suppression if their caregive...

High rate of loss to follow-up and virological non-suppression in HIV-infected children on antiretroviral therapy highlights the need to improve quality of care in South Africa

“…Among children who had a recent viral load, almost one-third of children experienced virological non-suppression in their first years on ART. This corresponds with recent studies (2017-2019) from low-and middle-income countries (LMICs) (28-38%) (5,(17)(18)(19)(20)(21)(22). However, two systematic reviews (both 20%) (22,23) and other studies have found lower proportions of virological non-suppression in children, including 12% in Ethiopia (6), 18% in South Africa (15) and 20% in Thailand (24).…”

HIGH-FREQUENCY failure of combination antiretroviral therapy in paediatric HIV infection is associated with unmet maternal needs causing maternal NON-ADHERENCE

“…Here we have found strong evidence showing cART failure in the child is due to cART non-adherence and is tightly linked to cART failure in the mother. The magnitude of relationship between mother and child suppression we found is much higher than has been recently described in older children [28], showing the critical role of the mother for consistent cART administration. On exploring the factors related to rate of infant viral rebound, counterintuitively, the strongest predictive factor was a longer duration of maternal cART in pregnancy.…”

Factors Associated with Poor Viral Suppression Among Children and Adolescents Accessing Antiretroviral Therapy in Selected Health Facilities in Lagos, Nigeria

“…Another study in Cambodia showed a relatively low viral suppression rate amongst adolescents compared to the adult population groups, with the viral suppression rate at 76.8% and 90% respectively [11]. In Kenya, children were more likely to be virally unsuppressed if their caregivers were not suppressed in comparison to children with caregivers that were virally suppressed [12]. Other associated factors with child viral non-suppression in children as stated in the study include younger child age at ART initiation and child tuberculosis treatment at the time of the viral load assay [13] Treatment for children and adolescents also presents several challenges including the complexity in ART dosing and the need to adjust doses as the child grows, which may be a problem especially for providers who are not skilled enough with children care or too busy to track the suppression status, which is not an uncommon scenario in low-resource settings where the paucity of healthcare workers is very signi cant [14].The associated factors of poor viral suppression in these patient group have not been well explored in secondary health care setting in Nigeria and it is important to elicit them with a view to utilizing the ndings to mitigate this.…”