Table 1.
Characteristics of Children and Adolescents Attending MHRP/PEPFAR-Supported Antiretroviral Treatment Programs in Kenya by Viral Suppression Status
| Viral Load <1000 Copies/mL (n = 750) | Viral Load >1000 Copies/mL (n = 185) | P | |
|---|---|---|---|
| Sex | .92 | ||
| Male | 364 (80.4%) | 89 (19.6%) | |
| Female | 386 (80.1%) | 96 (19.9%) | |
| Age | .48 | ||
| 1–9 years | 245 (81.7%) | 55 (18.3%) | |
| 10–14 years | 276 (78.2%) | 77 (21.8%) | |
| 15–19 | 229 (81.2%) | 53 (18.8%) | |
| Duration on ART | .11 | ||
| 6–12 months | 14 (70.0%) | 6 (30.0%) | |
| 13–24 months | 40 (71.4%) | 16 (28.6%) | |
| >24 months | 696 (81.0%) | 163 (19.0%) | |
| Current ART regimena | <.001 | ||
| ABC/3TC backboneb | 360 (81.4%) | 82 (18.6%) | |
| AZT/3TC backbonec | 160 (71.7%) | 63 (28.3%) | |
| TDF/3TC backbone | 49 (70.0%) | 21 (30.0%) | |
| TLD | 62 (96.9%) | 2 (3.1%) | |
| TLE | 119 (87.5%) | 17 (12.5%) | |
| Duration on current regimen >6 months | .43 | ||
| No | 136 (82.4%) | 29 (17.6%) | |
| Yes | 614 (79.7%) | 156 (20.3%) | |
| Current ART classd | <.001 | ||
| NRTI/NNRTI | 439 (81.9%) | 97 (18.1%) | |
| NRTI/PI | 246 (74.8%) | 83 (25.2%) | |
| INSTI-containing | 65 (92.9%) | 5 (7.1%) | |
| First- vs second-line ART | <.01 | ||
| First line | 505 (83.1%) | 103 (16.9%) | |
| Second line | 245 (74.9%) | 82 (25.1%) | |
| Number of referrals (quartiles)e | .13 | ||
| 0–4 | 201 (82.4%) | 43 (17.6%) | |
| 5–10 | 224 (80.9%) | 53 (19.1%) | |
| 11–23 | 151 (83.0%) | 31 (17.0%) | |
| 24+ | 174 (75.0%) | 58 (25.0%) | |
| Number of referrals for adherence counseling (quartiles)f | .02 | ||
| 0–2 | 229 (85.8%) | 38 (14.2%) | |
| 3–7 | 191 (78.3%) | 53 (21.7%) | |
| 8–13 | 164 (80.8%) | 39 (19.2%) | |
| 14+ | 166 (75.1%) | 55 (24.9%) | |
| Current WHO clinical stageg | .50 | ||
| I | 248 (83.2%) | 50 (16.8%) | |
| II | 257 (78.6%) | 70 (21.4%) | |
| III | 190 (80.2%) | 47 (19.8%) | |
| IV | 15 (75.0%) | 5 (25.0%) | |
| Unknown | 40 (75.5%) | 13 (24.5%) | |
| Current nutritional statush | .02 | ||
| No malnutrition | 692 (81.3%) | 159 (18.7%) | |
| Moderate/severe malnutrition | 23 (74.2%) | 8 (25.8%) | |
| Unknown | 35 (66.0%) | 18 (34.0%) | |
| History of tuberculosis treatmenti | .30 | ||
| No | 635 (80.9%) | 150 (19.1%) | |
| Yes | 94 (75.2%) | 31 (24.8%) | |
| Unknown | 21 (84.0%) | 4 (16.0%) | |
| Maternal viral loadj | <.01 | ||
| Mother living with HIV, viral load <1000 copies/mL | 270 (83.9%) | 52 (16.1%) | |
| Mother living with HIV, viral load >1000 copies/mL | 16 (59.3%) | 11 (40.7%) | |
| Mother HIV status or viral load unknown | 464 (79.2%) | 122 (20.8%) | |
| Child/adolescent experienced side effectsk | .62 | ||
| No | 579 (79.9%) | 146 (20.1%) | |
| Yes | 171 (81.4%) | 39 (18.6%) | |
| Doses of ART missed in past monthl | <.001 | ||
| None | 670 (81.6%) | 151 (18.4%) | |
| 1–2 | 53 (77.9%) | 15 (22.1%) | |
| 3+ | 27 (58.7%) | 19 (41.3%) | |
| Clinic support group participationm | .26 | ||
| Child <13 years | 419 (80.7%) | 100 (19.3%) | |
| Attends | 224 (77.5%) | 65 (22.5%) | |
| Does not attend | 107 (84.3%) | 20 (15.7%) | |
| Community support group participationn | .68 | ||
| Child <13 years | 419 (80.7%) | 100 (19.3%) | |
| Attends | 23 (85.2%) | 4 (14.8%) | |
| Does not attend | 308 (79.2%) | 81 (20.8%) | |
| Engaged in revenue-generating activityo | .59 | ||
| No | 193 (81.4%) | 44 (18.6%) | |
| Yes | 557 (79.8%) | 141 (20.2%) | |
| Household in urban or rural areap | .13 | ||
| Urban | 233 (81.2%) | 54 (18.8%) | |
| Peri-urban | 55 (71.4%) | 22 (28.6%) | |
| Rural | 462 (80.9%) | 109 (19.1%) | |
| Level of care deliveryq | <.01 | ||
| Level 1 health facility | 124 (71.3%) | 50 (28.7%) | |
| Level 2 health facility | 97 (77.6%) | 28 (22.4%) | |
| Level 3 health facility | 529 (83.2%) | 107 (16.8%) |
Data are presented as n (row %). Bold indicates significance at P < .05. Pearson’s chi-square and Wilcoxon rank-sum tests were used to compare participants with viral load <1000 copies/mL and those with viral load >1000 copies/mL. P values were not corrected for multiple-hypothesis testing. Facilities participating in this study include Kombewa, Manuyanda, Rodi, Kericho District Hospital, Bomet Health Centre, Sotik Health Centre, Kapkangani Health Centre, Kurangurik Dispensary, Sosiot Health Centre, Enoosaen Health Centre, Ndanai, Kipketer Dispensary, and Kabiyet Health Centre. Abbreviations: ABC, abacavir; ART, antiretroviral therapy; AZT, azidothymidine (zidovudine); DTG, dolutegravir; HIV, human immunodeficiency virus; INSTI, integrase strand transfer inhibitor; MHRP, Military HIV Research Program; NNRTI, non-nucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; PEPFAR, US President’s Emergency Plan for AIDS Relief; PI, protease inhibitor; TB, tuberculosis; TDF, tenofovir; TLD, tenofovir/lamivudine/dolutegravir; TLE, tenofovir/lamivudine/efavirenz; WHO, World Health Organization; 3TC, lamivudine.
Current ART regimen: ART regimen was obtained through medical and pharmacy record abstraction and grouped by common regimen/regimen backbone.
n = 4 on ABC/3TC/DTG.
n = 2 on AZT/3TC/DTG.
ART class: ART class was derived from ART regimen data obtained through medical and pharmacy record abstraction.
Number of referrals: Participants’ referral history was obtained through medical record abstraction of referrals for services including TB treatment, adherence counseling, nutrition support, inpatient care, mental services, psychosocial support, social support services, disclosure counseling, or other services not otherwise specified; the number of any referral services were totaled by participant and categorized by quartile.
Number of referrals for adherence counseling: Adherence counseling referrals were obtained through medical record abstraction; the number of adherence counseling referrals were totaled by participant and categorized by quartile.
WHO clinical stage: WHO staging was obtained through medical record abstraction at the most recent clinical care visit.
Nutritional status: Nutritional status was obtained through medical record abstraction at most recent clinical care visit and categorized according to the WHO classification scheme for malnutrition.
History of TB treatment: History of having ever received TB treatment was obtained through medical record abstraction.
Maternal viral load: Most recent maternal viral load was obtained through medical record abstraction where available; maternal viral load was categorized as viral load <1000 copies/mL, viral load >1000 copies/mL, or maternal HIV status or viral load unknown if maternal viral load was unknown/unavailable.
Ever experienced side effects: Participants 18–19 years, caregivers if the participant was younger than 13 years, and both caregivers and participants if the participant was between 13 and 17 years old were asked if they/the child had ever experienced side effects as a result of ART treatment; for participants 13–17 years, the caregiver response was taken as the primary response; however, if the caregiver response was missing, the participant response was utilized.
Doses of ART missed in the past month: Adolescents aged 18–19 years, caregivers if the participant was younger than 13 years, and both caregivers and participants if the participant was between 13 and 17 years were asked how many self-reported doses of ART medication they/the child had missed over the last month; responses were categorized into none, 1–2, or 3 or more missed ART doses in the past month; for participants aged 13–17 years, the caregiver response was taken as the primary response; however, if the caregiver response was missing, the participant response was utilized.
Clinic support group participation: Children and adolescents 13–19 years were asked if they participate in a support group at the clinic; children under age 13 were considered too young to participate as disclosure in this age group was not required for enrollment.
Community support group participation: Children and adolescents 13–19 years were asked if they participate in an HIV treatment support group in their community; children under age 13 were considered too young to participate as disclosure in this age group was not required for enrollment.
Engaged in revenue-generating activity: Adolescents 18–19 years, caregivers if the participant was younger than 13 years, and both caregivers and participants if the participant was between 13 and 17 years were asked whether they are currently involved in revenue generating activity; for participants aged 18–19 years old, the participant’s revenue-generating activity status was utilized while for participants younger than 18, the caregiver’s revenue generating activity status was utilized.
Household in urban or rural area: Adolescents 18–19 years and caregivers if the participant was younger than 18 years were asked if their household was in an urban, peri-urban, or rural area.
Level 1 health facility: Community facilities run by certified healthcare providers. Major roles are to treat minor ailments and issue referral letters to other facilities. Examples of activities are TB screening, contact tracing of TB patients and TB defaulters, screening for malnutrition, malaria rapid test, blood pressure and blood sugar testing, HIV testing services, and health talks. Level 2 health facility: Health dispensaries run by clinical officers (those in the cities also act as level 3 health facilities). Services include general outpatient as well as antenatal and postnatal services, no in-patient services. Level 3 health facility: Health centers (smaller hospitals) led by a nurse, a clinical officer, or at least with 1 medical officer. Services include maternity and in-patient services, antenatal and postnatal services, curative, laboratory, dental, and pharmacy. Level 4 health facility: County hospitals run by a director who is a medic, a doctor by profession. They offer more holistic services—as in level 3.