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Determinants of viral load suppression among orphaned and vulnerable children on antiretroviral treatment in Tanzania

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BACKGROUND: In Tanzania, only 47% of children on ART 0-14 years are virally suppressed (UNAIDS 2020). Although retention on and poor adherence to ART remain a challenge for children living with HIV (CLHIV), Orphans and Vulnerable Children (OVC) face greater limitations in accessing and utilizing comprehensive HIV care and treatment services. In response to this, the current study assessed the determinants of Viral Load Suppression (VLS) among OVC aged 0-14 years living with HIV enrolled in HIV community-based interventions.
METHODS: This study is based on data from the USAID Kizazi Kipya project (2016 ' 2021) from 81 councils of Tanzania. Included in this study are 1,980 CLHIV on ART (0-14 years) with valid Care and Treatment (CTC) identification numbers, enrolled and served by the project for 24 months. VLS was defined as viral load <1,000 copies/mL. Data analysis involved multivariate logistic regression, with VLS as the outcome of interest and HIV interventions and household characteristics as the main independent variables.
RESULTS: The overall viral suppression rate among OVC living with HIV was 85.3%. This rate increased with retention: 85.3%, 89.9%, 97.6% to 98.8% after 6, 12, 18 and 24 months of retention on ART, respectively. Similar rates were observed as the duration of adherence to ART increased. In the multivariate analysis, OVC attending PLHIV groups were 411 times more likely to be virally suppressed than those not attending (aOR=411.25, 95% CI 168.2'1005.4). OVC with health insurance were 6 times more likely to achieve viral suppression than those without (aOR=6.05, 95% CI 3.28'11.15). OVC from food secure households were almost 15 times more likely to be virally suppressed than their food insecure counterparts (aOR=14.93, 95% CI 8.76'25.45). OVC from households with five or more people were more likely to be virally suppressed than those in households with two people (aOR=2.97, 95% CI 1.25'7.07).
CONCLUSIONS: CLHIV reached by the different HIV community-based interventions were more likely to be virally suppressed than those who were not. To advance viral suppression, efforts should be made so that all CLHIV are reached by HIV community-based interventions as well as integrating food support in HIV treatment interventions.