| dc.description.abstract | Background: Virological suppression is critical to treatment success and reducing child morbidity and mortality. However, children continue to register low virological suppression of 41% in comparison to 70% suppression among adults. This study therefore assessed the factors associated with virological non-suppression among HIV-positive children (0-14) years receiving antiretroviral therapy.
Methods: The study was conducted at the pediatric HIV/AIDS clinic at Jinja Regional Referral Hospital and used a retrospective cohort study design through the review of medical records of children from 2019-2021; and a cross-sectional study to explore the experiences of health workers and caregivers of children with virological non-suppression. 221 children were enrolled in the cohort study and their medical records were reviewed. Hazard ratios were used to measure the association between virological non-suppression and child-clinical related factors. The hazard ratios were obtained using Cox proportional hazard model with 95% confidence intervals. Qualitative data was transcribed verbatim and typed into Microsoft Word. Transcribed data was then imported into ATLAS ti 6 for coding and determining emergent themes. Thematic analysis using the inductive approach was used.
Results: The incidence rate of virological non-suppression among children aged 0 to 14 on ART was 12 per 1000 person-months, following 24 months of ART initiation. Poor adherence (aHR 0.41, 95% CI: 0.20-0.81; p=0.01) was the child-related factor associated with virological non-suppression following 24 months of ART initiation. The qualitative findings from the health workers’ experiences revealed that factors such as heavy staff workload, challenges in disclosure, difficulties in accessing the health facility, and having multiple caregivers were related to virological non-suppression among children. From the caregivers’ experiences, factors such as stigma, gender-based violence, failure to disclose the HIV status to children and household members; and financial challenges were related to virological non-suppression among children.
Conclusion: HIV viral load non-suppression among children receiving ART is associated with poor adherence. The qualitative findings revealed that stigma, Gender based violence, non-disclosure by caregivers, heavy staff workload, and difficulties in accessing the health facility, and financial challenges contribute to poor adherence. Poor adherence should be addressed through interventions and strategies by HIV Program managers to improve viral suppression rate. | en_US |
