Patterns and PredictOrS of HIV Treatment FaIlures in Pediatric EnrOlled ClieNts in a Tertiary HeAlth Care FaciLity in Southeast Nigeria - POSITIONAL study

Introduction: Managing pediatric HIV remains a critical challenge, especially in low- and middle-income countries like Nigeria, where healthcare resources are limited, and the HIV burden is high. This study explored the prevalence and determinants of antiretroviral treatment (ART) failure among children in the region. Key factors such as demographic characteristics, clinical parameters, and adherence levels were analyzed to identify predictors of treatment failure. By addressing these factors, the research aims to enhance management strategies, improve outcomes, and contribute to achieving viral suppression. This effort underscores the importance of targeted interventions to improve the quality of life for children living with HIV in resource-limited settings. Method: A retrospective cross-sectional study aimed to identify the patterns and predictors of pediatric HIV treatment failure at Nnamdi Azikiwe University Teaching Hospital (NAUTH) in Nnewi, Southeast Nigeria using medical records data of enrolled pediatric HIV patients over five years, from January 2019 to December 2023. Result: The study population comprised individuals enrolled in the pediatric clinic of the healthcare facility. Most participants were female (50.6%) and students (44.8%). The pattern showed that most participants were underweight at baseline (81.0%), most respondents adhered well to their regimen (99.7%), and a high percentage achieved undetectable viral loads (76.4%). The data indicated significant improvements in both CD4 counts and BMI over time, highlighting the positive impact of the treatment and management strategies employed. Virological failure was the most common predictor of treatment failure. Also, younger age at ART initiation, higher baseline viral load, and lower baseline CD4 count were significant predictors of treatment failure. Limited access to second-line ART options and inconsistent viral load monitoring were significant healthcare system-related barriers, reflecting the resource challenges in many LMICs. Conclusion: The findings from the study provided valuable insights into the patterns and predictors of pediatric HIV treatment failure at NAUTH Nnewi, Southeast Nigeria, highlighted the complex interplay between patient-related and healthcare system factors in managing pediatric HIV, and underscored the need for targeted interventions to improve treatment outcomes in this vulnerable population.