Viral load testing coverage and suppression rate among children and adolescents on ART in Sierra Leone

SETTING: Anti-retroviral treatment (ART) centres from eight districts of Sierra Leone. OBJECTIVES: Among children and adolescents (0–19 years) registered for ART after January 2023 and currently on care, to assess i) viral load (VL) testing coverage and viral suppression, ii) turnaround time from sample collection to results, and iii) factors associated with not undergoing testing. DESIGN: A cohort study using programmatic data extracted from April to October 2025. RESULTS: Of 950 participants, 931 (98%) were eligible for VL testing (on ART for ≥6 months). Of the total participants, 286 (30%) underwent VL testing at least once (coverage), of which 247 (86%) had viral suppression. Median turnaround time was 36 days, ranging from 6 days in districts with centralised VL testing laboratory to 65 days in a district far from the central laboratory. Participants from ART centres situated in the Western Area Urban district (adjusted relative risk: 1.8, 95% confidence interval: 1.0–3.1) were at higher risk of not undergoing VL testing. CONCLUSION: Although high viral suppression was appreciable, less than one third of children and adolescents underwent VL testing with a long turnaround time, delaying virological failure detection and appropriate care. The national AIDS control programme should decentralise VL testing and strengthen sample transportation to ensure equitable access.