FACTORS ASSOCIATED WITH VIROLOGICAL NON-SUPPRESSION AMONG CHILDREN LIVING WITH HIV RECEIVING ART AT THE PEDIATRIC HIV/AIDS CLINIC AT JOINT CLINICAL RESEARCH CENTRE

Abstract

Background Worldwide, only 43% of children living with HIV are receiving antiretroviral therapy (ART). However, information on suppression rate and the factors associated with non-suppression among children LHIV on ART is limited. This study therefore set out to determine the factors associated with virological non-suppression among children living with HIV receiving ART. Method The study was done at the pediatric HIV/AIDS clinic at JCRC and used a retrospective cohort study design through the reviews of medical records and a cross- sectional qualitative approach to explore the caregivers‘ and health workers‘ perspectives on the factors related to virological non-suppression among children (0-14 years) and caregivers‘ experiences. For the retrospective cohort study, 300 participants were selected randomly using medical records and data was collected using a data abstraction form. For the qualitative approach, caregivers and health workers were purposively selected and data was collected using KII, FGD and IDI guides. Modified Poisson regression was used for bivariate and multivariate analysis at the level of significance 0.05. The qualitative data was analyzed using the thematic content analysis to generate codes, categories, sub themes and themes. Results The overall non-suppression rate within 6 months of receiving ART for the children was 23%. Older age at initiation IRR 0.34 CI [0.19-0.59], higher WHO clinical staging at initiation IRR 2.93 CI [1.55-5.52] and ART-induced side effects IRR 1.69 CI [1.06-2.68] were the child-related factors associated with non-suppression. From the caregivers‘ perspectives; lack of social support, stigma, and age of the caregiver, low education level of the care giver and HIV-status of the caregiver were some of the factors that were related to non-suppression among the children. The health care providers‘ perspectives indicated that; lack of pediatric fixed doses, difficulty in taking ARVs, ARV drug stock outs and poor quality of counseling were some of the factors that were related to virological non-suppression among children LHIV receiving ART. Conclusion Non-suppression among children LHIV on ART is an interplay between child, caregiver and health-care related factors that need to be simultaneously addressed through the design and modification of strategies or policies by the HIV-program managers to improve the suppression.