HIV Viral suppression following intensified adherence counseling among children on Antiretroviral therapy: Is it worth the wait?

Background With the current UNAIDS strategy of attaining 95-95-95 by the year 2030, HIV positive children should not be left behind. However, statistics show that HIV diagnosis in children lags behind that of adult, the number of newly diagnosed babies initiated on treatment is much lower than that in adults. Even when initiated on ART, viral suppression among children is much lower than in adults. There is need for a call to action. Methods This study was nested within the DRIBS ( D rug R esistance testing among I nfants at B aseline S tudy), which enrolled 100 infants at the time of treatment initiation between 2017–2023. Infants were followed for two years. Viral load (VL) was measured every six months and after completion of the three sessions of intensified adherence counseling (IAC). Results At the end of the two-year follow-up period, 63% of the children and 85% of the mothers had achieved complete viral suppression. Among mother-infant pairs, 36% of the virally non-suppressing children belonged to non-suppressing mothers. 20% of all children in the study exhibited persistent viral non-suppression at more than three time points during the course of the study. Among mothers with viral loads > 1000 copies/ml, 40% experienced persistent non-suppression. Self-reported adherence at each study visit revealed that at least 15% of the mothers reported poor adherence (adherence < 95%) and this was not different between a lopinavir-based and a dolutegravir-based regimen (14% and 11% respectively). Children were more likely to miss doses than mothers (p = 0.031). A repeat viral load after IAC revealed that 67% of the mothers achieved complete viral suppression. On the other hand, 28% of the children achieved complete viral suppression and 42% were unsuppressed. Conclusion Within mother-infant pairs, children exhibit poor viral suppression. This non-suppression persists among pediatrics despite intensified adherence counseling.