Factors associated with virologic re-suppression among children 1-9 years on anti-retroviral therapy at the AIDS Support Organization, Soroti Region, Uganda

Abstract

Background: Virologic re-suppression refers to a decrease in viral load below 1000 copies/ml for children who had achieved virological suppression but whose viral load levels were elevated thereafter despite the availability of antiretroviral therapy. Children in Uganda living with Human Immune Virus (HIV) continue to experience the lowest viral load re-suppression compared to adolescents and adults living with HIV despite various interventions such as; routine viral load monitoring and intensive adherence counselling. We aimed to determine the proportion that re-suppress following an un-suppressed viral load and the associated factors among children aged 1-9 years on Antiretroviral Therapy (ART) in The Aids Support Organization (TASO) Soroti region. Methods: This was a combined retrospective cohort and qualitative study which involved review of 401 records of children that initially had a suppressed viral load, failed and re-suppressed after six months from January 2016 to December 2018. This was done to determine the proportion that re-suppress following an un-suppressed viral load and the associated factors. Six key informant and nine in-depth interviews were conducted to explore the barriers and facilitators to virologic re-suppression among caregivers of HIV positive children on ART in TASO Soroti region. Quantitative data were collected from OPEN MRS and patient records using a data abstraction tool while qualitative data was collected using an in-depth and key informant interview guides. Modified Poisson regression was used for quantitative analysis to determine the factors associated with virologic re-suppression. Thematic content analysis was used for the qualitative component to identify barriers and facilitators to virologic re-suppression among caregivers of HIV positive children on ART in TASO Soroti region. Results: Of the 401 children, 24% (n=97) had a re-suppressed viral load. More than half of the children 53.1% (n=213) were females. Children aged between 8 and 9 years were 49% (n=197). The median age of these children was 8 (Interquartile range [IQR] 7-8) years and 62.6% (n=251) were initiated on ART when they were aged between 1-4 years. The factors that were significantly associated with virologic re-suppression included; being on an efavirenz based regimen [Adjusted Prevalence Ratio [Adj. PR=2.87, 95% CI 1.76, 4.79], having a good adherence to treatment after intensive adherence counseling [Adj.PR=1.71, 95% CI 1.22, 2.51] and the caregiver being HIV sero-positive [Adj.PR=2.56, 95% CI 1.69, 3.91]. Barriers to virologic re-suppression included; stigma, transport challenges, lack of support, perceived side effects of HIV drugs, machine breakdown, limited human resource and inadequate counselling services. Facilitators to virologic re-suppression included; presence of social support, perceived complications, caregivers’ relationship with the health workers, convenient services, hospitalization of children and care giver HIV status being positive. Conclusion: The proportion of children that had a re-suppressed viral load was low. Taking Efavirenz based treatment regimen, having a good adherence to treatment and HIV sero status of the caregiver being positive were predictors of virologic re-suppression. Close viral load monitoring and intensified targeted adherence support to the caregivers are vital to improve virologic re-suppression.