Prevalence and Correlates of Viral Load Suppression and Human Immunodeficiency Virus (HIV) Drug Resistance among Children and Adolescents in South Rift Valley and Kisumu, Kenya

Background: Children and adolescents living with HIV (CALHIV) face unique challenges, including poorer treatment outcomes, risk for drug-resistance mutations (HIVDRMs), and limited drug formulations. We estimated viral suppression (VS) prevalence and evaluated predictors of VS and HIVDRMs in Kenya. Methods: From 2018-2020, CALHIV 1-19 years on antiretroviral therapy (ART) >6 months were enrolled in this cross-sectional study. Participants underwent viral load (VL) testing; those with VL ≥1000 copies/mL had HIVDRM testing. Sociodemographic questionnaires and medical record abstraction were completed. VS prevalence (VL <1000 copies/mL) was estimated; robust Poisson regression models were used to estimate prevalence ratios (PRs) and 95% CIs for associations between potential predictors of VS. Results: Nine hundred and sixty-nine participants were enrolled. VS prevalence was. 80 (95% CI:. 78-.83). Being on ART >24 months (adjusted PR [aPR]: 1.22; 95% CI: 1.06-1.41), an integrase strand transfer inhibitor-containing regimen (1.13; 1.02-1.26), and attending a level 3 health facility (1.23; 1.11-1.36) were associated with VS. Missing ≥3 doses of ART in the past month (aPR:. 73; 95% CI:. 58-.92), having a viremic mother with HIV (.72;. 53-.98), and having 3-7 (.90;. 83-.97), 8-13 (.89;. 82-.97), or ≥14 (.84;. 77-.92) compared with <2 adherence counseling referrals were inversely associated with VS. A high proportion (n=119, 81.5%) of unsuppressed participants had evidence of any major HIVDRM. Conclusions: HIV treatment programs should target interventions for pediatric patients at risk for treatment failure - namely, those with a caregiver with failed VS and those struggling with adherence.