Introduction: Reducing and maintaining viral load is crucial to reducing morbidity and mortality associated with HIV infection in children. The aim of this study was to determine the factors influencing the maintenance of children and adolescents on antiretroviral therapy in the continuum of care. Methodology: This was a descriptive and analytical cross-sectional study conducted from August 1 to August 31, 2023. It included all children living with HIV, under 15 years of age, with at least two viral load results and whose parents consented to participate in the study. Participants were recruited during their child’s treatment renewal consultations. Results: The study included 143 children, mostly boys (55.2%), with a mean age of 11.54 years (±2.8). More than half (55.2) were unaware of their HIV-positive status, and most treatments were administered by parents (60.8%). Of the 99 children with an undetectable viral load at the first test, 23 (23.2%) showed a viral rebound at the last test, mainly due to poor treatment compliance (p < 0.001). Conclusion: Virological rebound after suppression in children is worrying. It is crucial that the national AIDS program improves Therapeutic Education, trains health workers to communicate results and encourages ongoing dialogue with young people to reinforce adherence and maintain viral suppression.
References
[1]
Tsikhutsu, I., Bii, M., Dear, N., Ganesan, K., Kasembeli, A., Sing’oei, V., et al. (2022) Prevalence and Correlates of Viral Load Suppression and Human Immunodeficiency Virus (HIV) Drug Resistance among Children and Adolescents in South Rift Valley and Kisumu, Kenya. ClinicalInfectiousDiseases, 75, 936-944. https://doi.org/10.1093/cid/ciac059
[2]
World Health Organization (2010) Traitement antirétroviral de l’infection à VIH chez le nourrisson et l’enfant: Vers un accès universel: Recommandations pour une approche de santé publique—mise à jour 2010. https://iris.who.int/handle/10665/44544
[3]
ONUSIDA (2023) La voie pour mettre fin au vih sida.
[4]
Machila, N., Libonda, L., Habineza, P., Velu, R.M., Kamboyi, H.K., Ndhlovu, J., et al. (2023) Prevalence and Predictors of Virological Failure in Pediatric Patients on HAART in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. PanAfricanMedicalJournal, 45, Article No. 98. https://doi.org/10.11604/pamj.2023.45.98.37017
[5]
Organisation Mondiale de la Santé. Principaux repères sur le VIH/sida. https://www.who.int/fr/news-room/fact-sheets/detail/hiv-aids
[6]
Osman, F.T. and Yizengaw, M.A. (2020) Virological Failure and Associated Risk Factors among HIV/AIDS Pediatric Patients at the ART Clinic of Jimma University Medical Center, Southwest Ethiopia. TheOpenAIDSJournal, 14, 61-67. https://doi.org/10.2174/1874613602014010061
[7]
Dobseu Soudebto, R.S., Fokam, J., Kamgaing, N., Fainguem, N., Ngoufack Jagni Semengue, E., Tommo Tchouaket, M.C., et al. (2024) Determinants of Immunovirological Response among Children and Adolescents Living with HIV-1 in the Central Region of Cameroon. TropicalMedicineandInfectiousDisease, 9, Article No. 48. https://doi.org/10.3390/tropicalmed9020048
[8]
(2022) Directives nationales de prévention, du dépistage, du traitement, de prestation de service et du suivi des personnes vivant avec le vih. 6ème. 108 p.
[9]
Shiferaw, M.B., Endalamaw, D., Hussien, M., Agegne, M., Amare, D., Estifanos, F., et al. (2019) Viral Suppression Rate among Children Tested for HIV Viral Load at the Amhara Public Health Institute, Bahir Dar, Ethiopia. BMCInfectiousDiseases, 19, Article No. 419. https://doi.org/10.1186/s12879-019-4058-4
[10]
Chandrasekaran, P., Shet, A., Srinivasan, R., Sanjeeva, G.N., Subramanyan, S., Sunderesan, S., et al. (2018) Long-Term Virological Outcome in Children Receiving First-Line Antiretroviral Therapy. AIDSResearchandTherapy, 15, Article No. 23. https://doi.org/10.1186/s12981-018-0208-9
[11]
Jobanputra, K., Parker, L.A., Azih, C., Okello, V., Maphalala, G., Kershberger, B., et al. (2015) Facteurs associés à l’échec virologique et à la suppression après un conseil amélioré en matière d’observance, chez les enfants, les adolescents et les adultes sous traitement antirétroviral contre le VIH au Swaziland. PLOSONE, 10, e0116144.
[12]
Muri, L., Gamell, A., Ntamatungiro, A.J., Glass, T.R., Luwanda, L.B., Battegay, M., et al. (2017) Development of HIV Drug Resistance and Therapeutic Failure in Children and Adolescents in Rural Tanzania. Aids, 31, 61-70. https://doi.org/10.1097/qad.0000000000001273
[13]
Opoku, S., Sakyi, S.A., Ayisi-Boateng, N.K., Enimil, A.K., Senu, E., Ansah, R.O., et al. (2022) Factors Associated with Viral Suppression and Rebound among Adult HIV Patients on Treatment: A Retrospective Study in Ghana. AIDSResearchandTherapy, 19, Article No. 21. https://doi.org/10.1186/s12981-022-00447-2
[14]
Kahabuka, M.S., Woldeamanuel, Y., Mbelele, P.M., Mpolya, E.A., Mpagama, S.G., Kessy, J.P., et al. (2024) HIV Viral Suppression and Risk of Viral Rebound in Patients on Antiretroviral Therapy: A Two-Year Retrospective Cohort Study in Northern Tanzania. BMCInfectiousDiseases, 24, Article No. 390. https://doi.org/10.1186/s12879-024-09161-y
[15]
Maina, E.K., Mureithi, H., Adan, A.A., Muriuki, J., Lwembe, R.M. and Bukusi, E.A. (2020) Incidences and Factors Associated with Viral Suppression or Rebound among HIV Patients on Combination Antiretroviral Therapy from Three Counties in Kenya. InternationalJournalofInfectiousDiseases, 97, 151-158. https://doi.org/10.1016/j.ijid.2020.05.097
[16]
Kakkar, F., Lee, T., Hawkes, M.T., Brophy, J., Lindy, S., Singer, J., et al. (2020) Challenges to Achieving and Maintaining Viral Suppression among Children Living with HIV. Aids, 34, 687-697. https://doi.org/10.1097/qad.0000000000002454
[17]
Childs, T., Shingadia, D., Goodall, R., Doerholt, K., Lyall, H., Duong, T., et al. (2015) Outcomes after Viral Load Rebound on First-Line Antiretroviral Treatment in Children with HIV in the UK and Ireland: An Observational Cohort Study. TheLancetHIV, 2, e151-e158. https://doi.org/10.1016/s2352-3018(15)00021-1
[18]
Craw, J.A., Beer, L., Tie, Y., Jaenicke, T., Shouse, R.L. and Prejean, J. (2020) Viral Rebound among Persons with Diagnosed HIV Who Achieved Viral Suppression, United States. JAIDSJournalofAcquiredImmuneDeficiencySyndromes, 84, 133-140. https://doi.org/10.1097/qai.0000000000002321
[19]
Afrane, A.K.A., Goka, B.Q., Renner, L., Yawson, A.E., Alhassan, Y., Owiafe, S.N., et al. (2021) HIV Virological Non-Suppression and Its Associated Factors in Children on Antiretroviral Therapy at a Major Treatment Centre in Southern Ghana: A Cross-Sectional Study. BMCInfectiousDiseases, 21, Article No. 731. https://doi.org/10.1186/s12879-021-06459-z
[20]
Farmer, K.C. (1999) Methods for Measuring and Monitoring Medication Regimen Adherence in Clinical Trials and Clinical Practice. ClinicalTherapeutics, 21, 1074-1090. https://doi.org/10.1016/s0149-2918(99)80026-5
[21]
Elizabeth Glaser Pediatric Aids Foundation (2019) Annoncer à un enfant ou un adolescent sa séropositivité au VIH-Boîte à outils.
[22]
Molokwane, M. and Madiba, S. (2021) Truth, Deception, and Coercion; Communication Strategies Used by Caregivers of Children with Perinatally Acquired HIV during the Pre-Disclosure and Post-Disclosure Period in Rural Communities in South Africa. Global Pediatric Health, 8, 72. https://doi.org/10.1177/2333794x211022269
[23]
Reif, L.K., et al. (2020) Interventions to Improve Antiretroviral Therapy Adherence among Adolescents and Youth in Low-and Middle-Income Countries: A Systematic Review 2015-2019. AidsandBehavior, 24, 2797-2810. https://link.springer.com/article/10.1007/s10461-020-02822-4
[24]
Haynes, R.B., Sackett, D.L. and Taylor, D.W. (1980) How to Detect and Manage Low Patient Compliance in Chronic Illness. Geriatrics, 35, 91-93.
[25]
de Jong, M.D., de Boer, R.J., de Wolf, F., Foudraine, N.A., Boucher, C.A.B., Goudsmit, J., et al. (1997) Overshoot of HIV-1 Viraemia after Early Discontinuation of Antiretroviral Treatment. Aids, 11, F79-F84. https://doi.org/10.1097/00002030-199711000-00002
[26]
Mouala, C., Roux, P., Okome, M., Sentenac, S., Okome, F., Nziengui, U., et al. (2006) Assessment of Compliance with ARV Treatment in Africa. MedecineTropicale: RevueduCorpsdeSanteColonial, 66, 610-614.
[27]
Delfraissy, J.F. (2002) Prise en charge des personnes infectées par le VIH: Recommandations du groupe d’experts. Flammarion Médecine-Sciences, 384.
[28]
Paterson, D.L., Swindells, S., Mohr, J., Brester, M., Vergis, E.N., Squier, C., et al. (2000) Adherence to Protease Inhibitor Therapy and Outcomes in Patients with HIV Infection. AnnalsofInternalMedicine, 133, Article No. 21. https://doi.org/10.7326/0003-4819-133-1-200007040-00004
[29]
Mbopi-Kéou, F., Djomassi, L.D. and Monebenimp, F. (2012) Etude des facteurs liés à l’observance au traitement antirétroviral chez les patients suivis à l’Unité de Prise En Charge du VIH/SIDA de l’Hôpital de District de Dschang, Cameroun. PanAfricanMedicalJournal, 12, Article No. 55. https://doi.org/10.11604/pamj.2012.12.55.1521
[30]
Bulage, L., Ssewanyana, I., Nankabirwa, V., Nsubuga, F., Kihembo, C., Pande, G., et al. (2017) Factors Associated with Virological Non-Suppression among HIV-Positive Patients on Antiretroviral Therapy in Uganda, August 2014-July 2015. BMCInfectiousDiseases, 17, Article No. 326. https://doi.org/10.1186/s12879-017-2428-3
[31]
O’Connor, J., Smith, C., Lampe, F.C., Johnson, M.A., Chadwick, D.R., Nelson, M., et al. (2017) Durability of Viral Suppression with First-Line Antiretroviral Therapy in Patients with HIV in the UK: An Observational Cohort Study. The Lancet HIV, 4, e295-e302.
[32]
Mussa, F.M., Massawe, H.P., Bhalloo, H., Moledina, S. and Assenga, E. (2022) Magnitude and Associated Factors of Anti-Retroviral Therapy Adherence among Children Attending HIV Care and Treatment Clinics in Dar Es Salaam, Tanzania. PLOSONE, 17, e0275420. https://doi.org/10.1371/journal.pone.0275420
