BACKGROUND: Children living with HIV (CLHIV) below the age of 5 years (<5) often have worse treatment outcomes and lower rates of virologic suppression (VS) than older children. Some pediatric centers have utilized resources to address possible barriers to VS including socioeconomic factors, stigma, poor peer or parental support, medication tolerability, etc.
METHODS: Data was extracted from December 2021 to November 2022 to investigate the outcomes of an interdepartmental Viremia Clinic started in February 2022 to improve clinic VS. The study included active clients at the Baylor College of Medicine Children’s Foundation - Tanzania clinic in Mbeya who had their viral load (VL) measured within the previous 12 months and had been on antiretroviral therapy (ART) for =6 months. Per national guidelines, the first-line ART regimen for children <20kg was abacavir-lamivudine-lopinavir/ritonavir (ABC-3TC-LPV/r) and dolutegravir (DTG) 50mg could be used if =20kg. Due to drug stock-outs, only LPV/r granules were available for most of the study period. Widespread use of pediatric DTG (dispersible tabs) began around August 2022.
RESULTS: VS in <5 was 80.9%(18/94) in December 2021 while the overall clinic suppression rate was 92.4%(1296/1402). Compared to ages =5 years, <5 VS was significantly lower (p<0.0001). <5 VS reached a nadir of 76.8%(76/99) before rising to 92.2%(94/102) by November 2022, surpassing the overall clinic VS of 91.7%(1239/1351) (see figure). In April 2022, the percentage of those failing who were <5 reached a maximum of 20.8%(21/101) but then fell to 7.1%(8/112) by November 2022.
CONCLUSIONS: Despite historical challenges in <5, we saw sustained improvements in VS rates that improved after the initiation of a Viremia Clinic and pediatric DTG. Moreover, clinic-wide rates of VS have begun to improve, though less dramatically than in <5.