Factors associated with viral load non-suppression among treatment-experienced pre-teenage children living with HIV in Kenya: a nationwide population-based cohort study, 2015–2021Research in context
Summary: Background: Viral load non-suppression (VLNS) in children is a major public health concern because of attendant HIV disease progression and risk of morbidity and mortality. Based on a nationally representative database we present estimates of the prevalence, trends and factors associated w...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-02-01
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| Series: | EClinicalMedicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537024000336 |
| _version_ | 1827360801889976320 |
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| author | Martin M. Mulinge Nancy K. Kibui Humphrey Kimani Joseph Wainaina Priska Bwana Martin Omondi Kevin Wafula Dalton C. Wamalwa Evans O. Omondi Ruth W. Nduati Matilu Mwau |
| author_facet | Martin M. Mulinge Nancy K. Kibui Humphrey Kimani Joseph Wainaina Priska Bwana Martin Omondi Kevin Wafula Dalton C. Wamalwa Evans O. Omondi Ruth W. Nduati Matilu Mwau |
| author_sort | Martin M. Mulinge |
| collection | DOAJ |
| description | Summary: Background: Viral load non-suppression (VLNS) in children is a major public health concern because of attendant HIV disease progression and risk of morbidity and mortality. Based on a nationally representative database we present estimates of the prevalence, trends and factors associated with VLNS in Kenyan pre-teenage children between 2015 and 2021. Methods: Kenya National AIDS & STI Control Program's (NASCOP) maintains an early infant diagnosis and viral load (EID/VL) database for all persons living with HIV who are enrolled in the country's primary care clinics for purposes of monitoring progress towards achievement of the 95% viral suppression goals. Participants were eligible if they were children living with HIV (CLHIV), on combination ART (cART) treatment, and ≤12 years old. The modified Mann–Kendall trend test for serially correlated data was used to identify VLNS trends. Generalized estimating equations (GEE) with a logit link was used to assess the effects of covariates on the odds of VLNS (VL ≥1,000 copies/mL) over repeated points in time, allowing for the correlation among the repeated measures. Findings: Between January 2015 and December 2021, 508,743 viral load tests were performed on samples collected from 109,682 pre-teenage children. The prevalence of VLNS decreased from 22.9% (95% CI 22.4–23.3) to 12.5% (95% CI 12.1–12.9), p < 0.0001, and mean age increased from 3.1 (4.2) to 8.0 (3.2) years in 2015 and 2021 respectively. A modified Mann–Kendall trend test for serially correlated data denotes a statistically significant decreasing trend (τ = −0.300, p < 0.0001) over the study period. In the multivariable GEE analysis adjusted for covariates, the odds of VLNS decreased by 11% per year during the study period, (GEE-aOR 0.89, 95% CI 0.88–0.90; p < 0.0001). Factors positively associated with VLNS were EFV/NVP-based first-line cART regimen (GEE-aOR 1.74, 95% CI 1.65–1.84, p < 0.0001), PI-based cART regimen (GEE-aOR 1.82, 95% CI 1.72–1.92, p < 0.0001), and children aged 1–3 years (toddlers) (GEE-aOR: 1.84, 95% CI 1.79–1.90, p < 0.0001). On the contrary, DTG-based cART regimen, were negatively associated with VLNS (GEE-aOR 0.70, 95% CI 0.65–0.75, p < 0.0001). Interpretation: There is a strong evidence of decreasing viremia between 2015 and 2021. To sustain the decreasing trend, accelerating the switch from the suboptimal EVP/NVP first-line regimen to optimised DTG regimen is warranted. Funding: U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and Clinton Health Access Initiative (CHAI). |
| first_indexed | 2024-03-08T06:53:41Z |
| format | Article |
| id | doaj.art-1bbb9c6025d54ab784ab6385421a5751 |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-03-08T06:53:41Z |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-1bbb9c6025d54ab784ab6385421a57512024-02-03T06:39:11ZengElsevierEClinicalMedicine2589-53702024-02-0168102454Factors associated with viral load non-suppression among treatment-experienced pre-teenage children living with HIV in Kenya: a nationwide population-based cohort study, 2015–2021Research in contextMartin M. Mulinge0Nancy K. Kibui1Humphrey Kimani2Joseph Wainaina3Priska Bwana4Martin Omondi5Kevin Wafula6Dalton C. Wamalwa7Evans O. Omondi8Ruth W. Nduati9Matilu Mwau10Department of Biochemistry, University of Nairobi, Nairobi, Kenya; Corresponding author. University of Nairobi, Chiromo Campus - Nairobi, 30197 - 00100, Kenya.Department of Biochemistry, University of Nairobi, Nairobi, Kenya; Centre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, KenyaCentre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, KenyaCentre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, KenyaCentre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, KenyaCentre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, KenyaCentre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, KenyaDepartment of Pediatrics and Child Health, University of Nairobi, Nairobi, KenyaAfrican Population and Health Research Center, Nairobi, Kenya; Institute of Mathematical Sciences, Strathmore University, Nairobi, KenyaDepartment of Pediatrics and Child Health, University of Nairobi, Nairobi, KenyaCentre for Infectious and Parasitic Diseases Control Research, Kenya Medical Research Institute, Busia, KenyaSummary: Background: Viral load non-suppression (VLNS) in children is a major public health concern because of attendant HIV disease progression and risk of morbidity and mortality. Based on a nationally representative database we present estimates of the prevalence, trends and factors associated with VLNS in Kenyan pre-teenage children between 2015 and 2021. Methods: Kenya National AIDS & STI Control Program's (NASCOP) maintains an early infant diagnosis and viral load (EID/VL) database for all persons living with HIV who are enrolled in the country's primary care clinics for purposes of monitoring progress towards achievement of the 95% viral suppression goals. Participants were eligible if they were children living with HIV (CLHIV), on combination ART (cART) treatment, and ≤12 years old. The modified Mann–Kendall trend test for serially correlated data was used to identify VLNS trends. Generalized estimating equations (GEE) with a logit link was used to assess the effects of covariates on the odds of VLNS (VL ≥1,000 copies/mL) over repeated points in time, allowing for the correlation among the repeated measures. Findings: Between January 2015 and December 2021, 508,743 viral load tests were performed on samples collected from 109,682 pre-teenage children. The prevalence of VLNS decreased from 22.9% (95% CI 22.4–23.3) to 12.5% (95% CI 12.1–12.9), p < 0.0001, and mean age increased from 3.1 (4.2) to 8.0 (3.2) years in 2015 and 2021 respectively. A modified Mann–Kendall trend test for serially correlated data denotes a statistically significant decreasing trend (τ = −0.300, p < 0.0001) over the study period. In the multivariable GEE analysis adjusted for covariates, the odds of VLNS decreased by 11% per year during the study period, (GEE-aOR 0.89, 95% CI 0.88–0.90; p < 0.0001). Factors positively associated with VLNS were EFV/NVP-based first-line cART regimen (GEE-aOR 1.74, 95% CI 1.65–1.84, p < 0.0001), PI-based cART regimen (GEE-aOR 1.82, 95% CI 1.72–1.92, p < 0.0001), and children aged 1–3 years (toddlers) (GEE-aOR: 1.84, 95% CI 1.79–1.90, p < 0.0001). On the contrary, DTG-based cART regimen, were negatively associated with VLNS (GEE-aOR 0.70, 95% CI 0.65–0.75, p < 0.0001). Interpretation: There is a strong evidence of decreasing viremia between 2015 and 2021. To sustain the decreasing trend, accelerating the switch from the suboptimal EVP/NVP first-line regimen to optimised DTG regimen is warranted. Funding: U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and Clinton Health Access Initiative (CHAI).http://www.sciencedirect.com/science/article/pii/S2589537024000336Antiretroviral therapy (ART)Generalized estimating equations (GEE)HIVKenyaPre-teenage childrenViral load non-suppression (VLNS) |
| spellingShingle | Martin M. Mulinge Nancy K. Kibui Humphrey Kimani Joseph Wainaina Priska Bwana Martin Omondi Kevin Wafula Dalton C. Wamalwa Evans O. Omondi Ruth W. Nduati Matilu Mwau Factors associated with viral load non-suppression among treatment-experienced pre-teenage children living with HIV in Kenya: a nationwide population-based cohort study, 2015–2021Research in context EClinicalMedicine Antiretroviral therapy (ART) Generalized estimating equations (GEE) HIV Kenya Pre-teenage children Viral load non-suppression (VLNS) |
| title | Factors associated with viral load non-suppression among treatment-experienced pre-teenage children living with HIV in Kenya: a nationwide population-based cohort study, 2015–2021Research in context |
| title_full | Factors associated with viral load non-suppression among treatment-experienced pre-teenage children living with HIV in Kenya: a nationwide population-based cohort study, 2015–2021Research in context |
| title_fullStr | Factors associated with viral load non-suppression among treatment-experienced pre-teenage children living with HIV in Kenya: a nationwide population-based cohort study, 2015–2021Research in context |
| title_full_unstemmed | Factors associated with viral load non-suppression among treatment-experienced pre-teenage children living with HIV in Kenya: a nationwide population-based cohort study, 2015–2021Research in context |
| title_short | Factors associated with viral load non-suppression among treatment-experienced pre-teenage children living with HIV in Kenya: a nationwide population-based cohort study, 2015–2021Research in context |
| title_sort | factors associated with viral load non suppression among treatment experienced pre teenage children living with hiv in kenya a nationwide population based cohort study 2015 2021research in context |
| topic | Antiretroviral therapy (ART) Generalized estimating equations (GEE) HIV Kenya Pre-teenage children Viral load non-suppression (VLNS) |
| url | http://www.sciencedirect.com/science/article/pii/S2589537024000336 |
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