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Jackson, Christi, Rehman, Andrea M., McHugh, Grace, Gonzalez-Martinez, Carmen, Ngwira, Lucky-Gift, Bandason, Tsitsi, Mujuru, Hilda, Odland, Jon O., Corbett, Elizabeth L., Ferrand, Rashida A. and Simms, Victoria (2022) 'Risk factors for sustained virological non-suppression among children and adolescents living with HIV in Zimbabwe and Malawi: a secondary data analysis'. BMC Pediatrics, Vol 22, Issue 1, e340.
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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 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.
| Item Type: | Article |
|---|---|
| Subjects: | WC Communicable Diseases > WC 20 Research (General) WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.5 Complications WS Pediatrics > By Age Groups > WS 460 Adolescence (General) |
| Faculty: Department: | Clinical Sciences & International Health > Clinical Sciences Department |
| Digital Object Identifer (DOI): | https://doi.org/10.1186/s12887-022-03400-4 |
| SWORD Depositor: | JISC Pubrouter |
| Depositing User: | JISC Pubrouter |
| Date Deposited: | 27 Sep 2022 13:47 |
| Last Modified: | 06 Jun 2023 16:56 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/20573 |
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