Viral Load Cascade for HIV Infected Children on Non-Nucleoside Reverse Transcriptase Inhibitor Based Firstline Regiment at Selected Health Facilities in western Kenya.

Abstract

Background: Viral load (VL) testing is critical in monitoring response to HIV treatment for children. Objectives: To describe access to VL testing and testing outcomes for children on Nevirapine or Efavirenz based first line antiretroviral treatment (ART). Design: Retrospective cohort study Setting: HIV clinics. Participants: Children aged 6 weeks to 14 years. Main outcome measures: VL test results, viral suppression, Methods: We reviewed records of children initiated on ART between 2010 and 2014. Clinic attendance within 90 days was considered active. Virological failure was defined as VL>1000copies/ml while repeat VL>1000c/ml qualified for regimen switch. Analysis used Stata Version 13.1 and Cox proportional hazard ratio was used to explore the association between outcome measures and sociodemographic at p≤0.05 level of significance Results: Of 3,432 eligible children, 69.1% had VL results and 69.5% achieved viral suppression. Of 3,118 active on ART, 73.1% had VL results and 70.1% achieved viral suppression compared to 314 attritions from care with 29.5% and 55.4% respectively (P<0.001). Fewer children on ART < 24 months had VL results compared to those on ART for longer, 52.1% vs 76.1% (p<0.001). Probability of virological failure was higher for males and duration on ART of > 24 months but lower for age 2 – 10 years and CD4 >500 cells/mm3 compared to age < 2 years and CD4 <350 cells/mm3 respectively. Of 809 (30%) children with virological failure, 81.1% had repeat VL results of whom 72.0% had VL >1000 copies/ml and 58.9% had regimen switch. Of the 809, 308 (38.1%) switched regimen without repeat VL results and 79.9% had follow up VL >1000 copies/ml. Conclusion: Although most children achieved viral suppression, gaps in access to timely VL testing remain a challenge. Children aged >24 months and those switched without repeat VL results need additional support to achieve viral suppression.