Abstract:
Objective: We conducted a retrospective cohort study to evaluate the efcacy of the World Health Organization
(WHO) “Universal Test and Treat” (UTT) policy, initiated in Kenya in September 2016. Under this policy, every human
immunodefciency virus (HIV)-infected person should be initiated on antiretroviral therapy (ART). We compared intraand inter-group viral suppression and ART adherence rates for pre-UTT (initiated on ART in March–August 2016) and
UTT groups (initiated in September 2016). The study was conducted in a community outreach Program in Nairobi
with 3500 HIV-infected children enrolled.
Results: 122 children and adolescents were initiated on frst-line ART pre-UTT, and 197 during the UTT period. The
6 month viral suppression rate was 79.7% pre-UTT versus 76.6% UTT (P < 0.05). Suboptimal adherence was higher in
the UTT than pre-UTT period (88 of 197, 44.7% and 44 of 122, 34%; P < 0.001). The decrease in adherence was greater
among orphans (91.7% pre-UTT and 87.2% UTT, P = 0.001) and children 11–18 years. Our results show that successful implementation of the UTT policy in Africa is challenged by an increased risk of suboptimal adherence. There is a
need to develop extra strategies to support adherence, especially among orphans and teenagers