BACKGROUND: Sub-Saharan Africa is home to nearly 90% of all children living with HIV (CLHIV). Overall paediatric HIV incidence declined by 54% from 2010 to 2020 globally, mainly due to the increased provision of antiretroviral therapy to pregnant and breastfeeding women living with HIV [1]. Despite progress in reducing HIV incidence in children, the region remains behind in reaching the 95-95-95 UNAIDS fast-track targets. Viral load suppression (VLS) is critical to treatment success and reducing child morbidity and mortality to accelerate progress towards ending AIDS. According to UNAIDS, only 40% of CLHIV had attained VLS, compared to 67% of adults in 2021 [2]. The 2015/16 MPHIA survey [3] reported that one in three children who had a viral load test had not achieved VLS.
Malawi has slightly above 1 million people living with HIV with 15% being children under the age of 14. The country has made strides to achieve UNAIDS fast-track targets with a performance of 88%:98%:97% among the 15+ cohort (MPHIA 2020/21). In 2021, ART Coverage in children was at 78% with all of them taking either LPV/r or NVP based regimens.

DESCRIPTION: We conducted a review of client-level data over a 12-month period to track the rates of VLS for children who had been taking pDTG-based ART. We reviewed national program data that was collected from client records in over 800 health facilities to compare the rates of VLS prior to introduction of pDTG in 2021 to 12-month post transition of all children to pDTG-based ART.
LESSONS LEARNED: pDTG rollout was initiated in July 2021 when national paediatric VLS was at 55%. By the end of a 12-month period, suppression rose to 73.5% which translates to 18.5% jump in 12 months. Similarly, proportion of children with viraemia of >1,000copies/mL had also decreased from about 27% to 16% in these 12 months.
CONCLUSIONS: The effect of pDTG on VLS is evident regardless of other associated factors such as adherence. National HIV programs need to finalize transitioning of all paediatric ART cohorts to pDTG while monitoring outcomes and other associated factors to achieve optimal VLS in children.

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