Abstract
Maintaining virologic suppression of children and adolescents on ART in rural communities in sub-Saharan Africa is challenging. We explored switching drug regimens to protease inhibitor (PI) based treatment and reducing nevirapine and zidovudine use in a differentiated community service delivery model in rural Zimbabwe. From 2016 through 2018, we followed 306 children and adolescents on ART in Hurungwe, Zimbabwe at Chidamoyo Christian Hospital, which provides compact ART regimens at 8 dispersed rural community outreach sites. Viral load testing was performed (2016) by Roche and at follow-up (2018) by a point of care viral load assay. Virologic failure was defined as viral load ≥1,000 copies/ml. A logistic regression model which included demographics, treatment regimens and caregiver's characteristics was used to assess risks for virologic failure and loss to follow-up (LTFU). At baseline in 2016, 296 of 306 children and adolescents (97%) were on first-line ART, and only 10 were receiving a PI-based regimen. The median age was 12 years (IQR 8-15) and 55% were female. Two hundred and nine (68%) had viral load suppression (<1,000 copies/ml) and 97(32%) were unsuppressed (viral load ≥1000). At follow-up in 2018, 42/306 (14%) were either transferred 23 (7%) or LTFU 17 (6%) and 2 had died. In 2018, of the 264 retained in care, 107/264 (41%), had been switched to second-line, ritonavir-boosted PI with abacavir as a new nucleotide analog reverse transcriptase inhibitor (NRTI). Overall viral load suppression increased from 68% in 2016 to 81% in 2018 (P<0.001). Viral load testing, and switching to second-line, ritonavir-boosted PI with abacavir significantly increased virologic suppression among HIV-infected children and adolescents in rural Zimbabwe.
Highlights
Maintaining virologic suppression of children and adolescents on antiretroviral therapy (ART) in rural communities in sub-Saharan Africa is challenging
This was a longitudinal study of Human Immunodeficiency Virus (HIV) infected children and adolescents receiving ART through Chidamoyo Christian Hospital (CCH) in north west Zimbabwe
In this follow-up sample, viral load suppression was ascertained by SAMBA-II semi-quantitative testing at CCH [31,32] and standard of Care—Roche assays at Chinhoyi Provincial Hospital
Summary
From 2016 through 2018, we followed 306 children and adolescents on ART in Hurungwe, Zimbabwe at Chidamoyo Christian Hospital, which provides compact ART regimens at 8 dispersed rural community outreach sites. A logistic regression model which included demographics, treatment regimens and caregiver’s characteristics was used to assess risks for virologic failure and loss to follow-up (LTFU). This was a longitudinal study of HIV infected children and adolescents receiving ART through CCH in north west Zimbabwe. Two years later in 2018, a follow-up sample was obtained at enrollment in the CBART clinical trial (NCT03986099) In this follow-up sample, viral load suppression was ascertained by SAMBA-II semi-quantitative testing at CCH [31,32] and standard of Care—Roche assays at Chinhoyi Provincial Hospital
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