The Suboptimal Pediatric HIV Viral Load Cascade: Multidistrict Cohort Study Among Children Taking Antiretroviral Therapy in Lesotho, Southern Africa. Issue 3 (March 2022)

• Record Type: Journal Article
• Authors: Muhairwe, Josephine A.; Brown, Jennifer A.; Motaboli, Lipontso; Nsakala, Bienvenu L.; Lerotholi, Malebanye; Amstutz, Alain; Klimkait, Thomas; Glass, Tracy R.; Labhardt, Niklaus D.
• Is Part Of: Pediatric infectious disease journal. Volume 41:Issue 3(2022)
• Publication Date: 2022-03
• Subjects: pediatrics -- viremia -- quality of health care -- medication adherence -- continuity of patient care; Communicable diseases in children -- Periodicals; Infection in children -- Periodicals; 618.929
• DOI: 10.1097/INF.0000000000003415
• Languages: English
• ISSNs: 0891-3668

Abstract

Abstract : Background: Children living with HIV and taking antiretroviral therapy (ART) are a priority group for routine viral load (VL) monitoring. As per Lesotho guidelines, a VL ≥1000 copies/mL ("unsuppressed") should trigger adherence counseling and a follow-up VL; 2 consecutive unsuppressed VLs ("virologic failure") qualify for switching to second-line ART, with some exceptions. Here, we describe the pediatric VL cascade in Lesotho. Methods: In a prospective open cohort study comprising routine VL results from 22 clinics in Lesotho, we assessed outcomes along the VL cascade for children who had at least 1 VL test from January 2016 through June 2020. Data were censored on February 10, 2021. Results: In total, 1215 children received 5443 VL tests. The median age was 10 years (interquartile range 7–13) and 627/1215 (52%) were female; 362/1215 (30%) had at least 1 unsuppressed VL. A follow-up VL was available for 325/362 (90%), although only for 159/362 (44%) within 6 months of the first unsuppressed VL. Of those with a follow-up VL, 172/329 (53%) had virologic failure and 123/329 (37%) qualified for switching to second-line ART. Of these, 55/123 (45%) were ever switched, although only 9/123 (7%) were switched within 12 weeks of the follow-up VL. Delays were more pronounced in rural facilities. Overall, 100/362 (28%) children with an unsuppressed VL received a timely follow-up VL and, if required, a timely regimen switch. Conclusions: Despite access to VL monitoring, clinical management was suboptimal. HIV programs should prioritize timely clinical action to maximize the benefits of VL monitoring.