Open AccessViral suppression among children and their caregivers living with HIV in western Kenya
Author(s) -
Humphrey John M,
Genberg Becky L,
Keter Alfred,
Musick Beverly,
Apondi Edith,
Gardner Adrian,
Hogan Joseph W,
WoolsKaloustian Kara
Publication year - 2019
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.1002/jia2.25272
Subject(s) - medicine , logistic regression , viral load , human immunodeficiency virus (hiv) , pediatrics , antiretroviral therapy , odds , odds ratio , immunology
Despite the central role of caregivers in managing HIV treatment for children living with HIV , viral suppression within caregiver–child dyads in which both members are living with HIV is not well described. Methods We conducted a retrospective analysis of children living with HIV <15 years of age and their caregivers living with HIV attending HIV clinics affiliated with the Academic Model Providing Access to Healthcare ( AMPATH ) in Kenya between 2015 and 2017. To be included in the analysis, children and caregivers must have had ≥1 viral load ( VL ) during the study period while receiving antiretroviral therapy ( ART ) for ≥6 months, and the date of the caregiver's VL must have occurred ±90 days from the date of the child's VL . The characteristics of children, caregivers and dyads were descriptively summarized. Multivariable logistic regression was used to estimate the odds of viral non‐suppression (≥ 1000 copies/ mL ) in children, adjusting for caregiver and child characteristics. Results Of 7667 children who received care at AMPATH during the study period, 1698 were linked to a caregiver living with HIV and included as caregiver–child dyads. For caregivers, 94% were mothers, median age at ART initiation 32.8 years, median CD 4 count at ART initiation 164 cells/mm 3 and 23% were not virally suppressed. For children, 52% were female, median age at ART initiation 4.2 years, median CD 4 values at ART initiation were 15% (age < 5 years) and 396 cells/mm 3 (age ≥ 5 years), and 38% were not virally suppressed. In the multivariable model, children were found more likely to not be virally suppressed if their caregivers were not suppressed compared to children with suppressed caregivers ( aOR = 2.40, 95% CI : 1.86 to 3.10). Other characteristics associated with child viral non‐suppression included caregiver ART regimen change prior to the VL , caregiver receipt of a non‐ NNRTI ‐based regimen at the time of the VL , younger child age at ART initiation and child tuberculosis treatment at the time of the VL . Conclusions Children were at higher risk of viral non‐suppression if their caregivers were not virally suppressed compared to children with suppressed caregivers. A child's viral suppression status should be closely monitored if his or her caregiver is not suppressed.