Viral load care of HIV-1 infected children and adolescents: A longitudinal study in rural Zimbabwe.

Mapangisana, Tichaona; Machekano, Rhoderick; Kouamou, Vinie; Maposhere, Caroline; McCarty, Kathy; Mudzana, Marceline; Munyati, Shungu; Mutsvangwa, Junior; Manasa, Justen; Shamu, Tinei; Bogoshi, Mampedi; Israelski, Dennis; Katzenstein, David (2021). Viral load care of HIV-1 infected children and adolescents: A longitudinal study in rural Zimbabwe. PLoS ONE, 16(1), e0245085. Public Library of Science 10.1371/journal.pone.0245085

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INTRODUCTION

Maintaining virologic suppression of children and adolescents on ART in rural communities in sub-Saharan Africa is challenging. We explored switching drug regimens to protease inhibitor (PI) based treatment and reducing nevirapine and zidovudine use in a differentiated community service delivery model in rural Zimbabwe.

METHODS

From 2016 through 2018, we followed 306 children and adolescents on ART in Hurungwe, Zimbabwe at Chidamoyo Christian Hospital, which provides compact ART regimens at 8 dispersed rural community outreach sites. Viral load testing was performed (2016) by Roche and at follow-up (2018) by a point of care viral load assay. Virologic failure was defined as viral load ≥1,000 copies/ml. A logistic regression model which included demographics, treatment regimens and caregiver's characteristics was used to assess risks for virologic failure and loss to follow-up (LTFU).

RESULTS

At baseline in 2016, 296 of 306 children and adolescents (97%) were on first-line ART, and only 10 were receiving a PI-based regimen. The median age was 12 years (IQR 8-15) and 55% were female. Two hundred and nine (68%) had viral load suppression (<1,000 copies/ml) and 97(32%) were unsuppressed (viral load ≥1000). At follow-up in 2018, 42/306 (14%) were either transferred 23 (7%) or LTFU 17 (6%) and 2 had died. In 2018, of the 264 retained in care, 107/264 (41%), had been switched to second-line, ritonavir-boosted PI with abacavir as a new nucleotide analog reverse transcriptase inhibitor (NRTI). Overall viral load suppression increased from 68% in 2016 to 81% in 2018 (P<0.001).

CONCLUSION

Viral load testing, and switching to second-line, ritonavir-boosted PI with abacavir significantly increased virologic suppression among HIV-infected children and adolescents in rural Zimbabwe.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

Graduate School:

Graduate School for Health Sciences (GHS)

UniBE Contributor:

Shamu, Tinei

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1932-6203

Publisher:

Public Library of Science

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

15 Jan 2021 16:10

Last Modified:

15 Jan 2021 16:18

Publisher DOI:

10.1371/journal.pone.0245085

PubMed ID:

33444325

BORIS DOI:

10.48350/151364

URI:

https://boris.unibe.ch/id/eprint/151364

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