Prevalence and Correlates of Viral Load Suppression and Human Immunodeficiency Virus (HIV) Drug Resistance Among Children and Adolescents in South Rift Valley and Kisumu, Kenya?

摘要

Abstract Background Children and adolescents living with HIV (CALHIV) face unique challenges, including poorer treatment outcomes, risk for drug-resistance mutations (HIVDRMs), and limited drug formulations. We estimated viral suppression (VS) prevalence and evaluated predictors of VS and HIVDRMs in Kenya.Methods From 2018–2020, CALHIV 1–19 years on antiretroviral therapy (ART) >6 months were enrolled in this cross-sectional study. Participants underwent viral load (VL) testing; those with VL ≥1000 copies/mL had HIVDRM testing. Sociodemographic questionnaires and medical record abstraction were completed. VS prevalence (VL 24 months (adjusted PR [aPR]: 1.22; 95% CI: 1.06–1.41), an integrase strand transfer inhibitor–containing regimen (1.13; 1.02–1.26), and attending a level 3 health facility (1.23; 1.11–1.36) were associated with VS. Missing ≥3 doses of ART in the past month (aPR: .73; 95% CI: .58–.92), having a viremic mother with HIV (.72; .53–.98), and having 3–7 (.90; .83–.97), 8–13 (.89; .82–.97), or ≥14 (.84; .77–.92) compared with <2 adherence counseling referrals were inversely associated with VS. A high proportion (n?=?119, 81.5%) of unsuppressed participants had evidence of any major HIVDRM.Conclusions HIV treatment programs should target interventions for pediatric patients at risk for treatment failure—namely, those with a caregiver with failed VS and those struggling with adherence.