Improving viral load suppression rate among paediatricpatientson anti-retroviral therapy in Central Province, Zambia

BACKGROUND: The aim of Antiretroviral Therapy (ART) is to attain and maintain Viral Suppression (VL) among People living with HIV(PLHIV). USAID SAFE program (SAFE) collaborated with the Ministry of Health (MOH) in Zambia to support facilities to ensure 95% of PLHIV on ART are virally suppressed. The suppression rate in SAFE supported facilities differs by age, with children below 15 years having lower suppression rate than adults. USAID SAFE worked with MOH to identify and address factors that were contributing to low viral suppression among children
DESCRIPTION: All Children files were reviewed in 31 selected SAFE supported facilities and the following factors were identified:

1. Health Facility related factors: such as suboptimal regimens, drug under dosing and underlying infections.
2. Client related factors: Such as poor drug storage, missing of drug dosages if no food available, if caretaker not home at the scheduled time of drugs to be taken, if a parent has not disclosed the HIV status of the child to a new spouse/partner, under dosing during drug administration.

SAFE implemented following interventions to address the problems:

1. Eligible children transitioned from Efavirenz (EFV) based regimen to more efficacious Dolutegravir (DTG) based regimen.
2. Pairing unsuppressed children with specific Community Based Volunteers (CBVs) for Enhanced Adherence Counselling sessions.
3. Home visits by Clinician and Community Based Volunteer to identify factors at home.
4. Specific days for paediatric clinics for virally unsuppressed children.
5. Pairing up Mother/Caretaker clinical appointment with the child's appointment.
6. Aligning clinical appointments for paediatrics with the school calendar and conducting after hours and weekend clinics.

LESSONS LEARNED: In October 2020, out of 2,160 children infected with HIV and enrolled on ART, only 1,746 (81%) were virally suppressed and 414 (19%) were unsuppressed. Following implementation of the above interventions, the VL steadily improved to 1,590 (90%) children were virally suppressed with 183 (10%) unsuppressed children.
CONCLUSIONS: While children may be managed at the health facility, client level factors are also key to attaining viral suppression. Therefore, MoH and all HIV treatment partners should work to identify and address both facility level and client level factors.

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