Abstract Background Viral suppression (VS) amongst children living with HIV (CLHIV) remains poor and several factors may affect sustained VS (SVS) over time. Methods We conducted a secondary analysis of data from a randomized control trial among CLHIV in western Kenya assessing individual, caregiver, and household factors associated with SVS, defined as viral load 1000 copies/ml throughout the study period of 12 months. We used multivariate logistic regression analysis, adjusting for additional covariates. Results A total of 668 CLHIV were included, median age of 9 years (interquartile range (IQR) 7-12) and time on ART 6 years (IQR 3-8). Using a VL cut off of 1000 copies/ml, the factors associated with lower odds of SVS were: (1) self-reported child’s poor ART adherence adjusted odds ratio (AOR) 0.43; 95% confidence interval (CI): (0.27, 0.69); (2) being on protease inhibitor-containing regimen AOR 0.49 (0.31, 0.79); (3) spending less than 30 minutes travelling to the facility AOR 0.59 (0.37, 0.95) and (4) having more VL results available for analysis AOR 0.80 (0.71, 0.90). At VL cut off of 200 copies/ml and 50 copies/ml, being on PI containing regimen and travel duration to clinic were no longer associated with SVS. However, at VL cut off of 50 copies/ml, additional factors associated with lower odds of SVS were less than 2 years on ART AOR 0.29 (0.14, 0.64) and caregiver depression AOR 0.61 (0.41, 0.91). Conclusion This analysis found that adherence on ART, years on ART, ART “anchor” drug, caregiver depression, travel duration to the health facility and number of VL assays were associated with SVS among CLHIV. Interventions to improve health outcomes for CLHIV should consider and address all relevant risk factors for viral non-suppression. Clinical Trial Number: NCT03820323
Oyaro et al. (Sat,) studied this question.