Effects of multi-month dispensing on viral suppression and continuity in treatment among children living with HIV aged 2 to 9 years: a cohort study in Western Kenya

Abstract

Background: In Kenya, of the 82,000 children living with HIV; only 59% of these children are receiving ART, and 67% of these are virally suppressed. Early in the COVID-19 pandemic, the Ministry of Health recommended three multi-month dispensing (3MMD) of ART to all people living with HIV, including children. This study assess the association between 3MMD and clinical outcomes among children in Western Kenya. Settings and Methods: We conducted a retrospective cohort study using routinely collected de-identified patient-level data from 43 facilities in Kisii and Migori counties. The study included children 2-9 years old who had been previously initiated on ART and sought HIV services between March 01, 2020, and March 30, 2021. We used generalized linear models with Poisson regression models to assess the association of MMD on retention at 6 months and viral suppression (<1,000 copies/ml). Results: Among the 963 children, 65.2% were aged 5-9 years old, and 50.7% were females. Seventy-eight percent received 3MMD at least once during the study period. Children who received 3MMD were 12% [adjusted risk ratio (aRR) (95% CI) =1.12 (1.01-1.24)] more likely to be retained and 22% [aRR =1.22 (1.12-1.34)] more likely to be virally suppressed than those on < 3MMD. When stratified by viral suppression at entry, the association between 3MMD and retention ([aRR= (95% CI) =1.22 (1.02-1.46)]) and viral suppression [aRR= (95% CI) =1.76 (1.30-2.37)] was significant among individuals who were unsuppressed at baseline. Conclusions: 3MMD was associated with comparable or improved HIV health outcomes among children.