Low-level viraemia and other factors associated with virologic outcomes among children living with HIV on antiretroviral therapy in Kenya, 2017–2023: a retrospective longitudinal analysis
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Kenya has expanded antiretroviral therapy (ART) coverage and improved viral suppression among children living with HIV (CLHIV). However, low-level viraemia (LLV) and clinical or programmatic factors may increase the risk of virologic failure (VF) and HIV drug resistance, threatening long-term treatment outcomes. We estimated LLV prevalence and its association with virologic outcomes among CLHIV in Kenya, along with other relevant factors. Methods: We conducted a retrospective analysis using data from Kenya's national HIV program database (2017-2023) for CLHIV aged 0-14 years on ART for ≥24 weeks with plasma-based viral load (VL) results. VL categories were undetectable VL (UVL; ≤50 copies/mL), LLV (51-999 copies/mL), and viral load non-suppression (VLNS; ≥1000 copies/mL). We assessed LLV prevalence and associations between initial VL and other factors with subsequent VLNS and VF (≥2 consecutive VLNS results) using non-time dependent and time-dependent multivariable models. Findings: Among 59,879 records, median age at initial VL was 7.6 years (IQR 4.2-11.3); 61.0% (36,524) had UVL, 20.6% (12,336) had LLV (51-199 copies/mL, 11.5% [6885]; 200-399 copies/mL, 4.7% [2785]; 400-999 copies/mL, 4.5% [2666]), and 18.4% (11,019) had VLNS. Across all VLs, 73.2% (43,843) achieved UVL, 29.7% (17,755) had LLV, and 4.4% (2614) experienced VF. Initial LLV increased risk of VLNS (adjusted relative risk [aRR] 1.87, 95% CI, 1.73-2.02) and VF (aRR 2.53, 95% CI, 2.03-3.15), highest at 400-999 copies/mL (VLNS aRR 2.64, 95% CI, 2.36-2.95); VF aRR 3.36, 95% CI, 2.46-4.59). Younger children (5-9 years) and those receiving dolutegravir-based ART had lower risk, while CLHIV in the Coast region had higher risk. Interpretation: These findings highlight the importance of timely viral load monitoring, practical adherence support interventions, and appropriate regimen review to address LLV in CLHIV and achieve sustained virologic suppression. Funding: This project was supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC).
Authors: Appolonia Aoko, Sherri Pals, Susan Gachau, Lennah Omoto, Immaculate Mutisya, Bianca Alvarez, Kenneth Masamaro, Evelyn Ngugi, Frank Basiye, Cathy Toroitich-Ruto, Timothy Ngugi, Peter Yegon, Maureen Kimani, Lilly Nyagah, Lazarus Momanyi, Barbara Mambo, Nancy Bowen, Salome Okutoyi, Rachael Joseph, Helen M Chun
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
Awards: GH21-2118: ENHANCING THE NATIONAL GOVERNMENT'S COORDINATION OF THE NATIONAL HIV PROGRAM TO ENSURE SUSTAINABILITY OF QUALITY AND COMPREHENSIVE HIV SERVICES IN KENYA UNDER THE PRESIDENT'S EMERGENCY PLAN FOR AIDS RELIEF (PEPFAR) - OBJECTIVETHE GRANT WILL ENHANCE THE NATIONAL GOVERNMENT'S COORDINATION OF THE NATIONAL HIV PROGRAM TO ENSURE SUSTAINABILITY OF QUALITY AND COMPREHENSIVE HIV SERVICES IN KENYA UNDER THE PRESIDENT'S EMERGENCY PLAN FOR AIDS RELIEF (PEPFAR).PROJECT SCOPETHE MINISTRY OF HEALTH HAS BEEN RECEIVING FUNDING THROUGH THE CDC COOPERATIVE AGREEMENT SINCE 2001. THIS IS THROUGH A FOUR FIVE-YEAR RENEWABLE GRANT THAT CDC HAS SUPPORTED KENYA MINISTRY OF HEALTH. THE KEY AREAS THAT PEPFAR FOCUSSES ON INCLUDE: ?SUPPORTING GOK MEET THE UNAIDS FASTTRACK TARGETS FOR 95-95-95 BY 2030 ( 95% OF HIV INFECTED PERSONS KNOW THEIR HIV STATUS, 95% OF THESE ARE ON TREATMENT , AND 95% OF THOSE ON TREATMENT HAVE VIRUS SUPPRESSED) GOALS THROUGH HIV TESTING AND COUNSELLING, QUALITY COMPREHENSIVE TREATMENT IMPLEMENTATION OF TEST AND START AND INCREASING COMMUNITY-BASED ADHERENCE AND RETENTION SUPPORT , AND MAINTAIN AND SUSTAIN DURABLE VIRAL SUPPRESSION.?FOCUSING ON KEY-POPULATIONS TYPOLOGIES: PEOPLE WHO INJECT DRUGS, FEMALE SEX WORKERS, TRANS-GENDER PERSONS, MEN HAVING SEX WITH MEN AND OTHER PRIORITY POPULATIONS INCLUDING MILITARY, FISHERFOLK AND PRISONERS WITH CRITICAL HIV PREVENTION, TREATMENT, AND CARE SERVICES ?EXPANDING ACTIVITIES UNDER THE DETERMINED, RESILIENT, EMPOWERED, AIDS-FREE, MENTORED AND SAFE (DREAMS) PARTNERSHIP, WHICH FOCUSES ON REDUCING HIV INFECTIONS AMONG ADOLESCENT GIRLS AND YOUNG WOMEN, TO SEVEN COUNTIES?REACHING MORE MEN WITH HIV SERVICES ? INCLUDING VOLUNTARY MEDICAL MALE CIRCUMCISION (VMMC), HIV TESTING, AND TREATMENT ?IMPROVING OUTCOMES FOR ORPHANS AND VULNERABLE CHILDREN BY LINKING BENEFICIARIES TO DREAMS ACTIVITIES, CLINICAL SERVICES, AND HOUSEHOLD ECONOMIC STRENGTHENING ?IDENTIFYING PRIORITY GAPS AND GENERATING QUALITY DATA BY WORKING ALONGSIDE THE GOVERNMENT OF KENYA TO IMPROVE KEY POPULATION SIZE ESTIMATES AND COMPLETE KENPHIA ? KENYA?S POPULATION-BASED HIV IMPACT ASSESSMENT ?STRENGTHENING GOVERNMENT FINANCIAL CONTRIBUTIONS TO THE HIV RES PONSE, COUNTY-LEVEL GOVERNANCE, SUPPLY CHAIN SYSTEMS, AND SUPPORT FOR BETTER DECISION-MAKING USING DATA, GH16-1627:PARTNERSHIP WITH THE MINISTRY OF HEALTH TO ACCELERATE SUSTAINABLE, HIGH QUALITY HIV/AIDS AND TB PROG
OpenAlex ID: W7140179909