Abstract
BackgroundThe UNAIDS 90–90-90 strategy clearly stipulates that 90% of all people on antiretroviral therapy (ART) should have a suppressed viral load. Intensified adherence counselling (IAC) was recently recommended by WHO to improve viral suppression among ART-treated paediatric and adolescent clients with virological failure. This paper describes the implementation and outcomes of IAC in the first year of implementation in a public ART program, to inform strategic interventions to reach the “third 90” among children.MethodsA retrospective chart review was conducted for all children aged 9 months to 19 years with HIV viral loads (VL) ≥ 1000 copies/ml at 15 public health facilities from June 2015–December 2016. Data on initial VL test results, IAC sessions, repeat VL test results, and ART regimen switch were abstracted and analysed for completion of IAC and viral suppression after IAC.ResultsA total of 449 children had a detectable viral load above 1000 copies/ml, after an average of 3.5 years (SD 5.8) years of ART. 192 (43%) were 10–20 years of age, and 320 (71%) were receiving Nevirapine-based ART regimen. Out of 345 (77%) who completed the recommended three IAC sessions, 62 (23%) achieved viral suppression following IAC. The mean time from 1st to 3rd IAC session was 113 (SD 153) days and 172 (50%) of the children had completed the three sessions within 200 days.ConclusionSuppression rates were low among ART-treated children with virological failure that completed the recommended three IAC sessions. As we move towards having 90% of ART-treated children and adolescents achieve and maintain viral suppression, there is need to re-evaluate the implementation of IAC among children and adolescents to consider both psychosocial and biological factors such as resistance testing for those with multiple detectable viral loads.
Highlights
The United Nations AIDS (UNAIDS) 90–90-90 strategy clearly stipulates that 90% of all people on antiretroviral therapy (ART) should have a suppressed viral load
Socio-demographic characteristics of participants Overall, there were 449 (16%) of all children in care who had a viral load above 1000 copies per ml
The children who had been on ART for less than 3.5 years had a mean age of 8.7 years, compared to 10.8 years for the ones who had been on ART for more than 3.5 years (p value < 0.001)
Summary
The UNAIDS 90–90-90 strategy clearly stipulates that 90% of all people on antiretroviral therapy (ART) should have a suppressed viral load. Intensified adherence counselling (IAC) was recently recommended by WHO to improve viral suppression among ART-treated paediatric and adolescent clients with virological failure. The third 90 clearly stipulates that 90% of all people receiving Antiretroviral Therapy (ART) should have HIV-RNA viral suppression [1]. Pediatric and adolescent clients (hereafter referred to as children) receiving ART, reportedly experience lower rates of viral suppression [2, 3] and would delay the achievement of this target if not given special consideration [4, 5]. It is important that children achieve protracted viral suppression during the lifelong ART to mitigate the exceptionally high mortality associated with unsuccessful HIV treatment [6]. Treatment failure among children is under diagnosed and given little attention by HIV programs [4, 10]
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