BACKGROUND: While the proportion of HIV-positive children (under 15 years) enrolled on antiretroviral therapy (ART) has increased in recent years, up to 60% of children started on ART do not achieve virological suppression. We set out to determine the factors associated with virological non-suppression among children living with HIV receiving ART at a peri-urban HIV care clinic in Kampala, Uganda. METHOD: This was a retrospective cohort study conducted at the pediatric HIV/AIDS clinic at the Joint Clinical Research Centre (JCRC) in Kampala, Uganda. Three hundred (300) HIV-positive children (0-14 years) were randomly selected from existing medical records and data on children's socio-demographic and clinical characteristics (age at ART initiation, WHO clinical staging, and ART-induced side effects) were abstracted using a data abstraction form. Virological non-suppression was defined as a viral load ≥1000 copies/Ml of blood after six months of ART initiation. Incident rate ratios (IRRs) were determined as a measure of association between virological non-suppression and child/patient characteristics. The IRRs were obtained via a modified Poisson regression with corresponding 95% confidence intervals (95%CI). All analyses were done using statistical package, Stata version 15. RESULTS: The overall non-suppression rate among HIV-positive children on ART was 23%. Being at WHO clinical stage 4 at ART initiation [adj. IRR 2.74; 95%CI: 1.63, 4.61] and ART-induced side effects [adj. IRR 1.77; 95%CI: 1.06, 2.97] were significantly associated with non-suppression. Older age at ART initiation (age 5-9 years: [adj. IRR 0.42; 95%CI: 0.28, 0.65]; age 10-14 years: [adj. IRR 0.34; 95%CI: 0.18, 0.64] was less likely to be associated with virological non-suppression. CONCLUSION: Nearly a quarter of HIV-positive children on ART had a non-suppressed viral load after six months of treatment. Being at WHO clinical stage 4 at ART initiation and ART-induced side effects were significantly associated with virological non-suppression while older age at ART initiation was protective. Our findings suggest a need for age-specific interventions, particularly those targeting children below five years of age, to improve virological suppression among HIV-positive children receiving ART in this setting.
BACKGROUND: While the proportion of HIV-positive children (under 15 years) enrolled on antiretroviral therapy (ART) has increased in recent years, up to 60% of children started on ART do not achieve virological suppression. We set out to determine the factors associated with virological non-suppression among children living with HIV receiving ART at a peri-urban HIV care clinic in Kampala, Uganda. METHOD: This was a retrospective cohort study conducted at the pediatric HIV/AIDS clinic at the Joint Clinical Research Centre (JCRC) in Kampala, Uganda. Three hundred (300) HIV-positive children (0-14 years) were randomly selected from existing medical records and data on children's socio-demographic and clinical characteristics (age at ART initiation, WHO clinical staging, and ART-induced side effects) were abstracted using a data abstraction form. Virological non-suppression was defined as a viral load ≥1000 copies/Ml of blood after six months of ART initiation. Incident rate ratios (IRRs) were determined as a measure of association between virological non-suppression and child/patient characteristics. The IRRs were obtained via a modified Poisson regression with corresponding 95% confidence intervals (95%CI). All analyses were done using statistical package, Stata version 15. RESULTS: The overall non-suppression rate among HIV-positive children on ART was 23%. Being at WHO clinical stage 4 at ART initiation [adj. IRR 2.74; 95%CI: 1.63, 4.61] and ART-induced side effects [adj. IRR 1.77; 95%CI: 1.06, 2.97] were significantly associated with non-suppression. Older age at ART initiation (age 5-9 years: [adj. IRR 0.42; 95%CI: 0.28, 0.65]; age 10-14 years: [adj. IRR 0.34; 95%CI: 0.18, 0.64] was less likely to be associated with virological non-suppression. CONCLUSION: Nearly a quarter of HIV-positive children on ART had a non-suppressed viral load after six months of treatment. Being at WHO clinical stage 4 at ART initiation and ART-induced side effects were significantly associated with virological non-suppression while older age at ART initiation was protective. Our findings suggest a need for age-specific interventions, particularly those targeting children below five years of age, to improve virological suppression among HIV-positive children receiving ART in this setting.
Authors: D L Paterson; S Swindells; J Mohr; M Brester; E N Vergis; C Squier; M M Wagener; N Singh Journal: Ann Intern Med Date: 2000-07-04 Impact factor: 25.391
Authors: Janneke H van Dijk; Catherine G Sutcliffe; Bornface Munsanje; Pamela Sinywimaanzi; Francis Hamangaba; Philip E Thuma; William J Moss Journal: PLoS One Date: 2011-04-28 Impact factor: 3.240
Authors: Ragna S Boerma; T Sonia Boender; Kim C E Sigaloff; Tobias F Rinke de Wit; Michael Boele van Hensbroek; Nicaise Ndembi; Titilope Adeyemo; Edamisan O Temiye; Akin Osibogun; Pascale Ondoa; Job C Calis; Alani Sulaimon Akanmu Journal: J Int AIDS Soc Date: 2016-11-10 Impact factor: 5.396
Authors: Cissy Kityo; Diana M Gibb; Charles F Gilks; Ruth L Goodall; Ivan Mambule; Pontiano Kaleebu; Deenan Pillay; Ronnie Kasirye; Peter Mugyenyi; A Sarah Walker; David T Dunn Journal: PLoS One Date: 2014-03-13 Impact factor: 3.240
Authors: Cissy Kityo; Ragna S Boerma; Kim C E Sigaloff; Elizabeth Kaudha; Job C J Calis; Victor Musiime; Sheila Balinda; Rita Nakanjako; T Sonia Boender; Peter N Mugyenyi; Tobias F Rinke de Wit Journal: J Antimicrob Chemother Date: 2017-09-01 Impact factor: 5.790
Authors: Roger T Buju; Pierre Z Akilimali; Erick N Kamangu; Gauthier K Mesia; Jean Marie N Kayembe; Hippolyte N Situakibanza Journal: Int J Environ Res Public Health Date: 2022-01-19 Impact factor: 3.390
Authors: Adenike O Soogun; Ayesha B M Kharsany; Temesgen Zewotir; Delia North; Ebenezer Ogunsakin; Perry Rakgoale Journal: Trop Med Infect Dis Date: 2022-09-06