Viral load monitoring practices and correlates of viral non-suppression among children and young adolescents living with HIV in level five hospitals in Kiambu county, Kenya

Abstract

AbstractBackgroundHIV has been a major global public health issue among children and young adolescents living with HIV (CYALHIV), their viral suppression rates being lower compared to adults. Follow up through viral load monitoring may influence their health outcomes.ObjectiveIn a cross-sectional study we determined viral load monitoring practices and correlates of viral non-suppression of all CYALHIV in three level five hospitals in Kiambu county, KenyaMethodsWe abstracted data from electronic and paper medical records. Multivariable log binomial regression was used to estimate prevalence ratios (PR) and assess correlates of non-suppression. Adherence to viral load testing guidelines was assessed. Viral non-suppression was defined as a VL >1000c/ml.ResultsOf the 252 CYALHIV, the median age was 11 (IQR: 7-13) years. Fourteen had non-suppression at last assessment. Correlates of non-suppression included having previously had TB [aPR=4.25; 95% CI=1.41-12.8; p=0.01], ART side effects [aPR=3.01; 95% CI=1.37-6.62 p=0.006] and having received enhanced adherence counselling [aPR =5.32; 95% CI=2.00-14.15; p=0.001]. Being on Dolutegravir was significantly associated with a lower likelihood of non-suppression (aPR=0.35; CI:0.15-0.85: p = 0.021). Timing of baseline VL tests improved through the years though there were gaps in routine VL monitoring and follow-up on unsuppressed results.ConclusionAt most current VL, 14% children were non-suppressed, higher than the 5% UNAIDS 2030 target. Special strategies on assessing and addressing corelates of non-suppression are essential for ART programs. Routine VL monitoring as per the guidelines was suboptimal despite increased access to VL testing, suggesting other barriers to VL monitoring.