Maternal engagement in HIV care associated with pediatric viral suppression

1. In this cross-sectional study from sub-Saharan Africa, maternal antiretroviral therapy use and viral load suppression were associated with greater antiretroviral therapy uptake among children.

2. Among countries with data for all children younger than 15 years, Namibia, Eswatini, and Lesotho had the highest rates of antiretroviral therapy uptake and viral load suppression.

Evidence Rating Level:  2 (Good)

Study Rundown: Despite the global decline in pediatric HIV infections, sub-Saharan Africa accounts for more than 80% of new infections among children. Children living with HIV (CLHIV) in the region continue to have suboptimal rates of antiretroviral therapy (ART) uptake and viral load suppression (VLS), both substantially lower than those among adults. This cross-sectional study aimed to estimate ART uptake and VLS among CLHIV in sub-Saharan Africa and examine their association with maternal engagement in HIV care. ART uptake and VLS increased with child age, with the lowest rates observed among children aged 0 to 4 years. Children of older mothers were also more likely to receive ART and achieve VLS. Among countries with data for children younger than 15 years, Namibia, Eswatini, and Lesotho had the highest rates of ART uptake and VLS. Zambia and Uganda had the lowest ART uptake, whereas Tanzania had the lowest prevalence of VLS. Maternal ART use was associated with greater ART uptake among children. Study limitations included the cross-sectional design, which precluded causal inferences; missing clinical data; reliance on household-based mother–child linkage; and the potential for residual confounding. Nevertheless, this study provides a clearer understanding of ART uptake and VLS among CLHIV in sub-Saharan Africa. Its findings suggest that maternal engagement in HIV care may promote ART uptake among children and, in turn, improve pediatric viral suppression.

Click here to read the study in JAMA Network Open

Relevant Reading: Second-Line Antiretroviral Therapy for Children Living with HIV in Africa

In-Depth [cross-sectional study]: This cross-sectional study aimed to estimate the prevalence of antiretroviral therapy  uptake and viral load suppression among children living with HIV across sub-Saharan Africa and to examine the role of maternal engagement in HIV care. Data were obtained from Population-based HIV Impact Assessment surveys conducted between 2015 and 2019 in 13 sub-Saharan African countries. HIV-positive children with available ART, VLS, and maternal data were included. All countries provided data for children aged 0 to 14 years, except Rwanda. Overall, 688 CLHIV younger than 15 years were included (48.7% male and 51.3% female). Children aged 0 to 4 years had the lowest rates of ART uptake and VLS, whereas those aged 10 to 14 years had the highest rates (ART uptake: 48.6% vs 78.1%; VLS: 27.5% vs 58.8%). ART uptake was higher among males than females (73.4% vs 68.0%), although VLS was lower among males (47.8% vs 52.4%). ART uptake was highest in Namibia (83.5%), Eswatini (74.8%), and Lesotho (73.4%), which also had the highest prevalence of VLS. Zambia had the lowest ART uptake (46.0%), whereas Tanzania had the lowest prevalence of VLS (30.4%). Children whose mothers were receiving ART were more likely to receive ART themselves (odds ratio [OR], 5.20.42; 95% confidence interval [CI], 8.77-47.54). Maternal VLS was similarly associated with child ART uptake (OR, 5.29; 95% CI, 2.95-9.48). Notably, children whose mothers had unknown ART status or were deceased were more likely to receive ART than those whose mothers were not receiving ART or had not achieved VLS. Consistent with previous evidence, child ART uptake was strongly associated with VLS. Overall, these findings characterize pediatric HIV treatment across sub-Saharan Africa and demonstrate an association between maternal engagement in HIV care and improved treatment outcomes among children.

Image: PD

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