HIV viral suppression after enhanced adherence counselling in children on dolutegravir-based regimens in Malawi

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Background: Viral suppression (VS) rates in children on antiretroviral therapy (ART) are lower than in adults. We described the effect of enhanced adherence counselling (EAC) on VS among children with high HIV viral load accessing dolutegravir (DTG)-based ART in a programme setting in Malawi. Objectives: This study evaluated the proportion of children with high viral load on DTG-based ART who re-suppressed following EAC and factors associated with VS post-EAC. Method: We included all patients aged < 15 years with a high viral load result (> 1000 copies/mL) after taking DTG-based ART for at least 6 months between January 2022 and March 2023, covering 104 healthcare facilities in Malawi. Descriptive statistics summarised the distribution of demographic and clinical characteristics. Multivariable logistic regression determined the factors associated with VS following EAC. Results: Overall, 1475 participants were enrolled; 884 (59.9%) were aged 10-14 years. A total of 1448 (98.2%) were enrolled in EAC, of whom 787 (54.3%), 308 (21.3%), and 353 (24.4%) completed three, two, and one session(s), respectively. Follow-up HIV viral load results were available for 1091 (74%) participants enrolled in EAC, and 782 (71.7%) achieved VS. Patients from urban areas were less likely to achieve VS post-EAC than those from rural areas (adjusted odds ratio [aOR]: 0.58, 95% confidence interval [CI]: 0.42-0.80). Conclusion: Nearly three-quarters of children with high viral load on DTG-based regimens achieved VS following EAC. Further research on the other contributors of virologic failure among children in Malawi is required.

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