Abstract
Provision of high-quality care and ensuring retention of children on antiretroviral therapy (ART) are essential to reduce human immunodeficiency virus (HIV)-associated morbidity and mortality. Virological non-suppression (≥1000 viral copies/ml) is an indication of suboptimal HIV care and support. This retrospective cohort study included ART-naïve children who initiated first-line ART between July 2015 and August 2017 in Johannesburg and rural Mopani district. Of 2739 children started on ART, 29.5% (807/2739) were lost to care at the point of analysis in August 2018. Among retained children, overall virological non-suppression was 30.2% (469/1554). Virological non-suppression was associated with higher loss to care 30.3% (229/755) compared with suppressed children (9.7%, 136/1399, P < 0.001). Receiving treatment in Mopani was associated with virological non-suppression in children under 5 years (adjusted odds ratio (aOR) 1.7 (95% confidence interval (CI) 1.1-2.4), 5-9 years (aOR 1.8 (1.1-3.0)) and 10-14 years (aOR 1.9 (1.2-2.8)). Virological non-suppression was associated with lower CD4 count in children 5-9 years (aOR 2.1 (1.1-4.1)) and 10-14 years (aOR 2.1 (1.2-3.8)). Additional factors included a shorter time on ART (<5 years aOR 1.8-3.7 (1.3-8.2)), and male gender (5-9 years, aOR1.5 (1.01-2.3)), and receiving cotrimoxazole prophylaxis (10-14 years aOR 2.0 (1.2-3.6)). In conclusion, virological non-suppression is a factor of subsequent programme loss in both regions, and factors affecting the quality of care need to be addressed to achieve the third UNAIDS 90 in paediatric HIV.
Highlights
South Africa has the largest paediatric human immunodeficiency virus (HIV) care and treatment programme in the world
In 2017, an estimated 280 000 children under 15 years of age were living with HIV in South Africa, of whom 58% were on antiretroviral therapy (ART) [1, 2]
A previous study by Lilian et al [3] showed that 20% of children who initiated ART between 2005 and 2014 in a rural South African area were lost to follow-up (LTFU) or had died, a minority, by 1 year on treatment
Summary
South Africa has the largest paediatric human immunodeficiency virus (HIV) care and treatment programme in the world. In 2017, an estimated 280 000 children under 15 years of age were living with HIV in South Africa, of whom 58% were on antiretroviral therapy (ART) [1, 2]. A previous study by Lilian et al [3] showed that 20% of children who initiated ART between 2005 and 2014 in a rural South African area were lost to follow-up (LTFU) or had died, a minority, by 1 year on treatment. The UNAIDS 90-90-90 targets include achieving viral suppression in 90% of children initiated on ART [4]. There is a significant proportion of children that do not reach sustained viral suppression in response to first-line ART [5]. Poor viral suppression in childhood continues to undermine the goals of ART
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