TY - JOUR
T1 - Risk factors for sustained virological non-suppression among children and adolescents living with HIV in Zimbabwe and Malawi: a secondary data analysis
AU - Jackson, Christi
AU - Rehman, Andrea M.
AU - McHugh, Grace
AU - Gonzalez-Martinez, Carmen
AU - Ngwira, Lucky Gift Chiwiya
AU - Bandason, Tsitsi
AU - Mujuru, Hilda
AU - Odland, Jon O.
AU - Corbett, Elizabeth L.
AU - Ferrand, Rashida A.
AU - Simms, Victoria
PY - 2022/6/11
Y1 - 2022/6/11
N2 - Background: We investigated risk factors for sustained virological non-suppression (viral load ≥ 1000 copies/ml on two tests 48 weeks apart) among children and adolescents accessing HIV care in public sector clinics in Harare, Zimbabwe and Blantyre, Malawi. Methods: Participants were enrolled between 2016 and 2019, were aged 6–19 years, living with HIV, had chronic lung disease (FEV z-score < -1) and had taken antiretroviral therapy (ART) for at least six months. We used multivariate logistic regression to identify risk factors for virological non-suppression after 48 weeks, among participants who were non-suppressed at enrolment. Results: At enrolment 258 participants (64.6%) were on first-line ART and 152/347 (43.8%) had virological non-suppression. After 48 weeks 114/313 (36.4%) were non-suppressed. Participants non-suppressed at baseline had almost ten times higher odds of non-suppression at follow-up (OR = 9.9, 95%CI 5.3–18.4, p < 0.001). Of those who were non-suppressed at enrolment, 87/136 (64.0%) were still non-suppressed at 48 weeks. Among this group non-suppression at 48 weeks was associated with not switching ART regimen (adjusted OR = 5.55; 95%CI 1.41–21.83); p = 0.014) and with older age. Twelve participants switched regimen in Zimbabwe and none in Malawi. Conclusions: Viral non-suppression was high among this group and many with high viral load were not switched to a new regimen, resulting in continued non-suppression after 48 weeks. Further research could determine whether improved adherence counselling and training clinicians on regimen switches can improve viral suppression rates in this population.
AB - Background: We investigated risk factors for sustained virological non-suppression (viral load ≥ 1000 copies/ml on two tests 48 weeks apart) among children and adolescents accessing HIV care in public sector clinics in Harare, Zimbabwe and Blantyre, Malawi. Methods: Participants were enrolled between 2016 and 2019, were aged 6–19 years, living with HIV, had chronic lung disease (FEV z-score < -1) and had taken antiretroviral therapy (ART) for at least six months. We used multivariate logistic regression to identify risk factors for virological non-suppression after 48 weeks, among participants who were non-suppressed at enrolment. Results: At enrolment 258 participants (64.6%) were on first-line ART and 152/347 (43.8%) had virological non-suppression. After 48 weeks 114/313 (36.4%) were non-suppressed. Participants non-suppressed at baseline had almost ten times higher odds of non-suppression at follow-up (OR = 9.9, 95%CI 5.3–18.4, p < 0.001). Of those who were non-suppressed at enrolment, 87/136 (64.0%) were still non-suppressed at 48 weeks. Among this group non-suppression at 48 weeks was associated with not switching ART regimen (adjusted OR = 5.55; 95%CI 1.41–21.83); p = 0.014) and with older age. Twelve participants switched regimen in Zimbabwe and none in Malawi. Conclusions: Viral non-suppression was high among this group and many with high viral load were not switched to a new regimen, resulting in continued non-suppression after 48 weeks. Further research could determine whether improved adherence counselling and training clinicians on regimen switches can improve viral suppression rates in this population.
KW - Adolescent
KW - Antiretroviral therapy
KW - Chronic lung disease
KW - HIV viral load
KW - Resistance
KW - Viral non-suppression
U2 - 10.1186/s12887-022-03400-4
DO - 10.1186/s12887-022-03400-4
M3 - Article
SN - 1471-2431
VL - 22
SP - e340
JO - BMC Pediatrics
JF - BMC Pediatrics
IS - 1
M1 - 340
ER -
