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The treatment cascade in children with unsuppressed viral load - a reality check in rural Lesotho, Southern Africa

Lejone, Thabo Ishmael and Ringera, Isaac and Cheleboi, Molisana and Wagner, Sarah and Muhairwe, Josephine and Klimkait, Thomas and Labhardt, Niklaus D.. (2018) The treatment cascade in children with unsuppressed viral load - a reality check in rural Lesotho, Southern Africa. Journal of Acquired Immune Deficiency Syndromes, 77 (3). pp. 250-256.

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Official URL: https://edoc.unibas.ch/60980/

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Abstract

As per the guidelines of the World Health Organization, HIV-infected children who do not achieve viral suppression while under antiretroviral therapy (ART) receive enhanced adherence counseling (EAC) with follow-up viral load (VL). A persisting unsuppressed VL after EAC triggers switch to a second-line regimen. We describe the care cascade of children with unsuppressed VL while taking ART.; Children, aged <16 years, on first-line ART for ≥6 months with unsuppressed VL (≥80 copies/mL) at first measurement were enrolled. As per guidelines, children/caregivers received EAC and a follow-up VL after 3 months, whereas those with persisting viremia despite good adherence were eligible for switching to second-line. Eighteen months after the first unsuppressed VL, outcomes were assessed.; Of 191 children receiving a first-time VL in May/June 2014, 53 (28%) had unsuppressed viremia. The care cascade of these 53 children was as follows: 49 (92%) received EAC and a follow-up VL in October 2014 (1 died, 3 lost to follow-up). 36/49 (73%) stayed unsuppressed, but only 24 were switched to second-line. At 18-months follow-up, 10 (19%) were retained in care with suppressed VL, 26 were retained with ongoing viremia (49%), 2 (4%) had died, and 15 (28%) had no VL documentation.; Only 1 of 5 children with unsuppressed initial VL under ART was retained in care and virally suppressed at 18 months of follow-up. ART programs must increase the focus onto the extremely vulnerable care cascade in children with unsuppressed VL.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH)
09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Medicine > Clinical Research (Reither)
UniBasel Contributors:Labhardt, Niklaus
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Lippincott, Williams & Wilkins
ISSN:1525-4135
e-ISSN:1944-7884
Note:Publication type according to Uni Basel Research Database: Journal article
Identification Number:
Last Modified:27 Jun 2018 09:37
Deposited On:27 Jun 2018 09:37

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