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Risk factors for sustained virological non-suppression among children and adolescents living with HIV in Zimbabwe and Malawi: a secondary data analysis
We investigated risk factors for sustained virological non-suppression (viral load ≥ 1000 copies/ml on two tests 48 weeks apart) among children and adolescents accessing HIV care in public sector clinics in Harare, Zimbabwe and Blantyre, Malawi. Participants were enrolled between 2016 and 2019, were...
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| Published in: | BMC pediatrics 2022-06, Vol.22 (1), p.340-9, Article 340 |
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| creator | Jackson, Christi Rehman, Andrea M McHugh, Grace Gonzalez-Martinez, Carmen Ngwira, Lucky G Bandason, Tsitsi Mujuru, Hilda Odland, Jon O Corbett, Elizabeth L Ferrand, Rashida A Simms, Victoria |
| description | We investigated risk factors for sustained virological non-suppression (viral load ≥ 1000 copies/ml on two tests 48 weeks apart) among children and adolescents accessing HIV care in public sector clinics in Harare, Zimbabwe and Blantyre, Malawi.
Participants were enrolled between 2016 and 2019, were aged 6-19 years, living with HIV, had chronic lung disease (FEV z-score |
| doi_str_mv | 10.1186/s12887-022-03400-4 |
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Participants were enrolled between 2016 and 2019, were aged 6-19 years, living with HIV, had chronic lung disease (FEV z-score < -1) and had taken antiretroviral therapy (ART) for at least six months. We used multivariate logistic regression to identify risk factors for virological non-suppression after 48 weeks, among participants who were non-suppressed at enrolment.
At enrolment 258 participants (64.6%) were on first-line ART and 152/347 (43.8%) had virological non-suppression. After 48 weeks 114/313 (36.4%) were non-suppressed. Participants non-suppressed at baseline had almost ten times higher odds of non-suppression at follow-up (OR = 9.9, 95%CI 5.3-18.4, p < 0.001). Of those who were non-suppressed at enrolment, 87/136 (64.0%) were still non-suppressed at 48 weeks. Among this group non-suppression at 48 weeks was associated with not switching ART regimen (adjusted OR = 5.55; 95%CI 1.41-21.83); p = 0.014) and with older age. Twelve participants switched regimen in Zimbabwe and none in Malawi.
Viral non-suppression was high among this group and many with high viral load were not switched to a new regimen, resulting in continued non-suppression after 48 weeks. Further research could determine whether improved adherence counselling and training clinicians on regimen switches can improve viral suppression rates in this population.
Secondary cohort analysis of data from BREATHE trial (Clinicaltrials.gov NCT02426112 ).</description><identifier>ISSN: 1471-2431</identifier><identifier>EISSN: 1471-2431</identifier><identifier>DOI: 10.1186/s12887-022-03400-4</identifier><identifier>PMID: 35690762</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adolescent ; Age groups ; Anti-HIV Agents - therapeutic use ; Antiretroviral drugs ; Antiretroviral therapy ; Antiviral agents ; Child ; Chronic lung disease ; Counseling ; Data Analysis ; Development and progression ; Drug dosages ; Drug therapy ; Education ; HIV ; HIV infection in children ; HIV Infections - drug therapy ; HIV Infections - epidemiology ; HIV viral load ; Human immunodeficiency virus ; Humans ; Investigations ; Lung diseases ; Malawi - epidemiology ; Measurement ; Pediatric research ; Pediatrics ; Resistance ; Risk Factors ; Sociodemographics ; Teenagers ; Viral Load ; Viral non-suppression ; Viremia ; Zimbabwe - epidemiology</subject><ispartof>BMC pediatrics, 2022-06, Vol.22 (1), p.340-9, Article 340</ispartof><rights>2022. The Author(s).</rights><rights>COPYRIGHT 2022 BioMed Central Ltd.</rights><rights>2022. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c594t-c936489c7b53ba766848625ad06f9884632cb3e7b39f5657006dbccb1fc7b3773</citedby><cites>FETCH-LOGICAL-c594t-c936489c7b53ba766848625ad06f9884632cb3e7b39f5657006dbccb1fc7b3773</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9188224/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2678205831?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35690762$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jackson, Christi</creatorcontrib><creatorcontrib>Rehman, Andrea M</creatorcontrib><creatorcontrib>McHugh, Grace</creatorcontrib><creatorcontrib>Gonzalez-Martinez, Carmen</creatorcontrib><creatorcontrib>Ngwira, Lucky G</creatorcontrib><creatorcontrib>Bandason, Tsitsi</creatorcontrib><creatorcontrib>Mujuru, Hilda</creatorcontrib><creatorcontrib>Odland, Jon O</creatorcontrib><creatorcontrib>Corbett, Elizabeth L</creatorcontrib><creatorcontrib>Ferrand, Rashida A</creatorcontrib><creatorcontrib>Simms, Victoria</creatorcontrib><title>Risk factors for sustained virological non-suppression among children and adolescents living with HIV in Zimbabwe and Malawi: a secondary data analysis</title><title>BMC pediatrics</title><addtitle>BMC Pediatr</addtitle><description>We investigated risk factors for sustained virological non-suppression (viral load ≥ 1000 copies/ml on two tests 48 weeks apart) among children and adolescents accessing HIV care in public sector clinics in Harare, Zimbabwe and Blantyre, Malawi.
Participants were enrolled between 2016 and 2019, were aged 6-19 years, living with HIV, had chronic lung disease (FEV z-score < -1) and had taken antiretroviral therapy (ART) for at least six months. We used multivariate logistic regression to identify risk factors for virological non-suppression after 48 weeks, among participants who were non-suppressed at enrolment.
At enrolment 258 participants (64.6%) were on first-line ART and 152/347 (43.8%) had virological non-suppression. After 48 weeks 114/313 (36.4%) were non-suppressed. Participants non-suppressed at baseline had almost ten times higher odds of non-suppression at follow-up (OR = 9.9, 95%CI 5.3-18.4, p < 0.001). Of those who were non-suppressed at enrolment, 87/136 (64.0%) were still non-suppressed at 48 weeks. Among this group non-suppression at 48 weeks was associated with not switching ART regimen (adjusted OR = 5.55; 95%CI 1.41-21.83); p = 0.014) and with older age. Twelve participants switched regimen in Zimbabwe and none in Malawi.
Viral non-suppression was high among this group and many with high viral load were not switched to a new regimen, resulting in continued non-suppression after 48 weeks. Further research could determine whether improved adherence counselling and training clinicians on regimen switches can improve viral suppression rates in this population.
Secondary cohort analysis of data from BREATHE trial (Clinicaltrials.gov NCT02426112 ).</description><subject>Adolescent</subject><subject>Age groups</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral therapy</subject><subject>Antiviral agents</subject><subject>Child</subject><subject>Chronic lung disease</subject><subject>Counseling</subject><subject>Data Analysis</subject><subject>Development and progression</subject><subject>Drug dosages</subject><subject>Drug therapy</subject><subject>Education</subject><subject>HIV</subject><subject>HIV infection in children</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - epidemiology</subject><subject>HIV viral load</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Investigations</subject><subject>Lung diseases</subject><subject>Malawi - epidemiology</subject><subject>Measurement</subject><subject>Pediatric research</subject><subject>Pediatrics</subject><subject>Resistance</subject><subject>Risk Factors</subject><subject>Sociodemographics</subject><subject>Teenagers</subject><subject>Viral Load</subject><subject>Viral non-suppression</subject><subject>Viremia</subject><subject>Zimbabwe - epidemiology</subject><issn>1471-2431</issn><issn>1471-2431</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNptks1u1DAUhSMEoqXwAiyQJSTEJsU_iX9YIFUV0EpFSAhYsLFubGfGxRNP7WRGfRJeF89MKTMIZeHY97vH9vGpqucEnxIi-ZtMqJSixpTWmDUY182D6pg0gtS0YeTh3v9R9STna4yJkA1_XB2xlissOD2ufn3x-SfqwYwxZdTHhPKUR_CDs2jlUwxx5g0ENMShztNymVzOPg4IFnGYITP3wSZXpoNFYGNw2bhhzCj4lS_1tR_n6OLyO_ID-uEXHXRrt2U_QYC1f4sAZWfiYCHdIgsjlCKE2-zz0-pRDyG7Z3fjSfXtw_uv5xf11eePl-dnV7VpVTPWRjHeSGVE17IOBOeykZy2YDHvlSyXZdR0zImOqb7lrcCY286YjvSlhQnBTqrLna6NcK2XyS_KUXQEr7cLMc00pNGb4DRxUiqpFIAzTetaySztVWusIdQJI4vWu53WcuoWzm6cSBAORA8rg5_rWVxpRaSk5Z1Oqtd3AineTC6PeuGLoSHA4OKUNeWi5ZgpjAv68h_0Ok6pmLelJMXleOQvNYNyAT_0sexrNqL6TGAuuaINLdTpf6jyWbfw5XVc78v6QcOrvYa5gzDOcwzTWJKRD0G6A02KOSfX35tBsN5kWO8yrEuG9TbDeuPCi30b71v-hJb9Bkka7Oo</recordid><startdate>20220611</startdate><enddate>20220611</enddate><creator>Jackson, Christi</creator><creator>Rehman, Andrea M</creator><creator>McHugh, Grace</creator><creator>Gonzalez-Martinez, Carmen</creator><creator>Ngwira, Lucky G</creator><creator>Bandason, Tsitsi</creator><creator>Mujuru, Hilda</creator><creator>Odland, Jon O</creator><creator>Corbett, Elizabeth L</creator><creator>Ferrand, Rashida A</creator><creator>Simms, Victoria</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><general>BMC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20220611</creationdate><title>Risk factors for sustained virological non-suppression among children and adolescents living with HIV in Zimbabwe and Malawi: a secondary data analysis</title><author>Jackson, Christi ; Rehman, Andrea M ; McHugh, Grace ; Gonzalez-Martinez, Carmen ; Ngwira, Lucky G ; Bandason, Tsitsi ; Mujuru, Hilda ; Odland, Jon O ; Corbett, Elizabeth L ; Ferrand, Rashida A ; Simms, Victoria</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c594t-c936489c7b53ba766848625ad06f9884632cb3e7b39f5657006dbccb1fc7b3773</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Adolescent</topic><topic>Age groups</topic><topic>Anti-HIV Agents - therapeutic use</topic><topic>Antiretroviral drugs</topic><topic>Antiretroviral therapy</topic><topic>Antiviral agents</topic><topic>Child</topic><topic>Chronic lung disease</topic><topic>Counseling</topic><topic>Data Analysis</topic><topic>Development and progression</topic><topic>Drug dosages</topic><topic>Drug therapy</topic><topic>Education</topic><topic>HIV</topic><topic>HIV infection in children</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - epidemiology</topic><topic>HIV viral load</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Investigations</topic><topic>Lung diseases</topic><topic>Malawi - epidemiology</topic><topic>Measurement</topic><topic>Pediatric research</topic><topic>Pediatrics</topic><topic>Resistance</topic><topic>Risk Factors</topic><topic>Sociodemographics</topic><topic>Teenagers</topic><topic>Viral Load</topic><topic>Viral non-suppression</topic><topic>Viremia</topic><topic>Zimbabwe - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jackson, Christi</creatorcontrib><creatorcontrib>Rehman, Andrea M</creatorcontrib><creatorcontrib>McHugh, Grace</creatorcontrib><creatorcontrib>Gonzalez-Martinez, Carmen</creatorcontrib><creatorcontrib>Ngwira, Lucky G</creatorcontrib><creatorcontrib>Bandason, Tsitsi</creatorcontrib><creatorcontrib>Mujuru, Hilda</creatorcontrib><creatorcontrib>Odland, Jon O</creatorcontrib><creatorcontrib>Corbett, Elizabeth L</creatorcontrib><creatorcontrib>Ferrand, Rashida A</creatorcontrib><creatorcontrib>Simms, Victoria</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content (ProQuest)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>BMC pediatrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jackson, Christi</au><au>Rehman, Andrea M</au><au>McHugh, Grace</au><au>Gonzalez-Martinez, Carmen</au><au>Ngwira, Lucky G</au><au>Bandason, Tsitsi</au><au>Mujuru, Hilda</au><au>Odland, Jon O</au><au>Corbett, Elizabeth L</au><au>Ferrand, Rashida A</au><au>Simms, Victoria</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Risk factors for sustained virological non-suppression among children and adolescents living with HIV in Zimbabwe and Malawi: a secondary data analysis</atitle><jtitle>BMC pediatrics</jtitle><addtitle>BMC Pediatr</addtitle><date>2022-06-11</date><risdate>2022</risdate><volume>22</volume><issue>1</issue><spage>340</spage><epage>9</epage><pages>340-9</pages><artnum>340</artnum><issn>1471-2431</issn><eissn>1471-2431</eissn><abstract>We investigated risk factors for sustained virological non-suppression (viral load ≥ 1000 copies/ml on two tests 48 weeks apart) among children and adolescents accessing HIV care in public sector clinics in Harare, Zimbabwe and Blantyre, Malawi.
Participants were enrolled between 2016 and 2019, were aged 6-19 years, living with HIV, had chronic lung disease (FEV z-score < -1) and had taken antiretroviral therapy (ART) for at least six months. We used multivariate logistic regression to identify risk factors for virological non-suppression after 48 weeks, among participants who were non-suppressed at enrolment.
At enrolment 258 participants (64.6%) were on first-line ART and 152/347 (43.8%) had virological non-suppression. After 48 weeks 114/313 (36.4%) were non-suppressed. Participants non-suppressed at baseline had almost ten times higher odds of non-suppression at follow-up (OR = 9.9, 95%CI 5.3-18.4, p < 0.001). Of those who were non-suppressed at enrolment, 87/136 (64.0%) were still non-suppressed at 48 weeks. Among this group non-suppression at 48 weeks was associated with not switching ART regimen (adjusted OR = 5.55; 95%CI 1.41-21.83); p = 0.014) and with older age. Twelve participants switched regimen in Zimbabwe and none in Malawi.
Viral non-suppression was high among this group and many with high viral load were not switched to a new regimen, resulting in continued non-suppression after 48 weeks. Further research could determine whether improved adherence counselling and training clinicians on regimen switches can improve viral suppression rates in this population.
Secondary cohort analysis of data from BREATHE trial (Clinicaltrials.gov NCT02426112 ).</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>35690762</pmid><doi>10.1186/s12887-022-03400-4</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | BMC pediatrics, 2022-06, Vol.22 (1), p.340-9, Article 340 |
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| subjects | Adolescent Age groups Anti-HIV Agents - therapeutic use Antiretroviral drugs Antiretroviral therapy Antiviral agents Child Chronic lung disease Counseling Data Analysis Development and progression Drug dosages Drug therapy Education HIV HIV infection in children HIV Infections - drug therapy HIV Infections - epidemiology HIV viral load Human immunodeficiency virus Humans Investigations Lung diseases Malawi - epidemiology Measurement Pediatric research Pediatrics Resistance Risk Factors Sociodemographics Teenagers Viral Load Viral non-suppression Viremia Zimbabwe - epidemiology |
| title | Risk factors for sustained virological non-suppression among children and adolescents living with HIV in Zimbabwe and Malawi: a secondary data analysis |
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