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. 2018 Aug 22;18(1):1048.
doi: 10.1186/s12889-018-5964-x.

Low HIV viral suppression rates following the intensive adherence counseling (IAC) program for children and adolescents with viral failure in public health facilities in Uganda

Esther Nasuuna  1 , Joanita Kigozi  2 , Lillian Babirye  2 , Alex Muganzi  2 , Nelson K Sewankambo  3 , Damalie Nakanjako  2   3
Affiliations

Low HIV viral suppression rates following the intensive adherence counseling (IAC) program for children and adolescents with viral failure in public health facilities in Uganda

Esther Nasuuna et al. BMC Public Health. .

Abstract

Background: The UNAIDS 90-90-90 strategy clearly stipulates that 90% of all people on antiretroviral therapy (ART) should have a suppressed viral load. Intensified adherence counselling (IAC) was recently recommended by WHO to improve viral suppression among ART-treated paediatric and adolescent clients with virological failure. This paper describes the implementation and outcomes of IAC in the first year of implementation in a public ART program, to inform strategic interventions to reach the "third 90" among children.

Methods: A retrospective chart review was conducted for all children aged 9 months to 19 years with HIV viral loads (VL) ≥ 1000 copies/ml at 15 public health facilities from June 2015-December 2016. Data on initial VL test results, IAC sessions, repeat VL test results, and ART regimen switch were abstracted and analysed for completion of IAC and viral suppression after IAC.

Results: A total of 449 children had a detectable viral load above 1000 copies/ml, after an average of 3.5 years (SD 5.8) years of ART. 192 (43%) were 10-20 years of age, and 320 (71%) were receiving Nevirapine-based ART regimen. Out of 345 (77%) who completed the recommended three IAC sessions, 62 (23%) achieved viral suppression following IAC. The mean time from 1st to 3rd IAC session was 113 (SD 153) days and 172 (50%) of the children had completed the three sessions within 200 days.

Conclusion: Suppression rates were low among ART-treated children with virological failure that completed the recommended three IAC sessions. As we move towards having 90% of ART-treated children and adolescents achieve and maintain viral suppression, there is need to re-evaluate the implementation of IAC among children and adolescents to consider both psychosocial and biological factors such as resistance testing for those with multiple detectable viral loads.

Keywords: Adolescents; Antiretroviral therapy; Detectable viral load; Intensive adherence counseling (IAC); Pediatric; Uganda; Viral load monitoring.

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Conflict of interest statement

Ethics approval and consent to participate

Ethical approval for retrospective analysis and dissemination of results from routine program data was obtained from the School of Health Sciences Research Ethics Committee at Makerere University College of Health Sciences (REC No: 2017–083). Since this was a retrospective analysis of de-identified data a waiver of consent was also obtained from the same IRB. The Uganda National Council for Science and technology also provided approval (SS 4538).

Consent for publication

Not applicable

Competing interests

The authors declare that they do not have competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Showing actions taken for those that completed three IAC sessions compared to those who did not go through the three IAC sessions
Fig. 2
Fig. 2
Time to 1st IAC session from date of detectable viral load
Fig. 3
Fig. 3
Showing the time in days to completion of 3rd IAC sessions after a detectable viral load result
Fig. 4
Fig. 4
Showing time from the 3rd IAC Session to repeat viral load by those who are suppressed compared to those who are not suppressed
See this image and copyright information in PMC

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