Adoption of routine virologic testing and predictors of virologic failure among HIV-infected children on antiretroviral treatment in western Kenya

Abstract

BackgroundAccess to routine virologic monitoring, critical to ensuring treatment success, remains limited in low- and middle-income countries. We report on implementation of routine viral load (VL) monitoring and risk factors for virologic failure among HIV-infected children on antiretroviral treatment (ART) in Western Kenya.MethodsRoutine VL testing was introduced in western Kenya in November 2013. We performed a case-control study among 1190 HIV-infected children ≤15 years on ART who underwent routine VL testing June 2014–May 2015. A random sample of 98 cases (virologic failure define as VL >1000 cps/mL) and 201 controls (VL <1000 cps/mL) from five facilities in three high HIV prevalence counties in Kenya were followed for a minimum of 12 months. Data from patient charts were analyzed using logistic regression to determine factors associated with failure to attain virologic suppression at initial routine and subsequent VL testing among cases.ResultsOverall, 1190 (94%) children with a median age of 8 years underwent routine VL testing of whom (37%) had virological failure. Among the 299 cases and controls, WHO stage, baseline CD4 count and time since ART initiation were not associated with virologic failure during the follow-up period. In multivariable analysis, unsuppressed children at initial test were more likely to be male (adjusted Odds Ratio (aOR) 2.1, 95% Confidence Interval (CI) 2.1–3.6) and have had an ART regimen change (aOR 2.0, CI 1.0–3.7) than controls. Of the two-thirds of children 201/299 who had a subsequent VL performed, VL suppression was greater among those suppressed at initial test 126/135 (93.3%) compared to children with virologic failure 15/66 (22.7%, p<0.0001). Among those failing at first test who achieved viral suppression in follow up, 12/15 (80%) were on a protease inhibitor (PI)-based regimen. In the multivariable analysis of children with subsequent VL testing, children on PI-based 2nd line regimens were 10-fold more likely to achieve viral suppression than children on first-line NNRTI-based ART (adjusted Odds Ratio [aOR] 0.1; 95%CI 0.0–0.4).ConclusionCoverage of initial routine viral load testing among children on ART in western Kenya is high. However, subsequent testing and virologic suppression are low in children with virologic failure on initial routine viral load test. There is an urgent need to improve management and viral load monitoring of children living with HIV experiencing treatment failure to ensure improved long-term outcomes.

Performance and Outcomes of Routine Viral Load Testing in People Living with HIV Newly Initiating ART in the Integrated HIV Care Program in Myanmar between January 2016 and December 2017

“…Fourth, risk factors for virologic failure in both cohorts were advanced HIV-related disease and/or immunosuppression. These findings are in line with previous reports [ 29 , 30 , 31 ], although associations between advanced HIV disease and virologic failure are not always consistent [ 32 , 33 ]. Being married or widowed offered protection in the 12-month cohort against virologic failure and this is possibly due to the supportive efforts of spouses/families in ensuring adherence to treatment and compliance with follow-up.…”

Magnitude and Associated Factors of Virological Failure Among Children on ART in Bahir Dar Town Public Health Facilities, Northwest Ethiopia: a Facility Based Cross-sectional Study

“…This study also revealed opportunistic infections during follow-up were strongly associated with the occurrence of virological failure. This result is concordant with other reports from Tanzania (19) and Kenya (25), which demonstrated that co-morbidities such as TB (one of the opportunistic infections) were associated with the occurrence of virological failure. This is well-known that co-morbidities such as TB weaken the immune system among patients and rapidly increase HIV disease progression to its advanced stage.…”

“…Kenya (25), which demonstrated that co-morbidities such as TB (one of the opportunistic infections) were associated with the occurrence of virological failure. This is well-known that co-morbidities such as TB weaken the immune system among patients and rapidly increase HIV disease progression to its advanced stage.…”

Rate and predictors of Treatment Failure among pediatric population taking Highly Active Antiretroviral Therapy in Ethiopia

“…From the studies conducted in Nigeria and Cambodia risk factors for ART treatment failure were ARV exposure and sever immunosuppression before start of ART [26]. From a study conducted in Kenya, the factors were base line CD4 below 50 cells [29]. From these studies, the risk factors including low base line CD4 and poor adherence were found to be significant associated factors for ART treatment failure.…”