Abstract:
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 nonsuppressed
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.
TRIAL RGISTRATION : Secondary cohort analysis of data from BREATHE trial (Clinicaltrials.gov NCT02 426112).
Description:
AVAILABILITY OF DATA AND MATERIALS : The datasets used and/or analysed during the current study are not available
publicly since the trial was performed at a time when data sharing was not
the norm, and therefore participant consent for wider sharing of data was not
obtained, but datasets are available from the corresponding author on reasonable
request after following institutional requirements.