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Mother-child dyads living with HIV in the Western Cape, South Africa: Undetectable = Undetectable?
Kim Anderson1, Helena Rabie2, Brian S Eley3
1Centre for Integrated Data and Epidemiological Research, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Insights
Fewer than half of children living with HIV achieved viral suppression (VS) on antiretroviral therapy (ART). Maternal viral suppression significantly improved child VS, highlighting the need for integrated mother-child care to achieve optimal outcomes.
Area of Science:
- Pediatric Infectious Diseases
- HIV/AIDS Research
- Public Health
Background:
- Children living with HIV (CLHIV) globally have lower viral suppression (VS) rates compared to UNAIDS targets.
- Limited studies link mother-child data to understand VS factors in young CLHIV.
- This study examines VS in a setting with early infant HIV testing and protease inhibitor-based ART.
Purpose of the Study:
- To describe viral suppression (VS) rates among young children living with HIV (CLHIV) in Western Cape, South Africa.
- To identify factors associated with VS in CLHIV receiving early infant diagnosis and treatment.
- To assess the impact of maternal viral load on child VS outcomes.
Main Methods:
- Analysis of routinely collected mother-child data for children born 2018-2022.
- Assessment of VS at 12 and 24 months post-ART initiation using logistic regression.
- Adjustment for child sex, birth year, immunodeficiency severity, maternal age, and diagnosis timing.
Main Results:
- Among 2219 CLHIV, 90% initiated ART; VS rates were 36% at 12 months, 43% at 24 months, and 48% at 36 months post-ART.
- Maternal viral load <100 copies/ml was strongly associated with higher child VS at 12 (aOR=3.5) and 24 months (aOR=6.1).
- Children with no/mild immunodeficiency were more likely to achieve VS at 12 months (aOR=2.3). Missing VL data at 24 months correlated with significant care gaps.
Conclusions:
- Less than half of children on ART achieved viral suppression.
- Maternal viral suppression is a key factor for achieving VS in children living with HIV.
- Integrated support for mother-child dyads is crucial for optimizing VS outcomes.
Introduction:
Globally, children living with HIV continue to lag behind UNAIDS targets for viral suppression (VS). Because studies with linked mother-child data are limited, we describe VS and associated factors among young children in a setting with early infant HIV testing (at birth, age 10 weeks and 6 months) and early protease inhibitor-based first-line antiretroviral therapy (ART).
Methods:
We analysed routinely collected mother-child data for children living with HIV born 2018-2022 in Western Cape province, South Africa (followed through mid-2023). We assessed associations between child and maternal viral load (VL) results at 12 and 24 months after child ART start using logistic regression, adjusted for child sex, birthyear, severity of child immunodeficiency at ART start, maternal age and timing of maternal HIV diagnosis.
Results:
Among 2219 children living with HIV; 30% were diagnosed at birth (≤7 days), 41% before age 1 year (8-365 days) and 29% at age >1 year. Overall, 5% (n = 112/2219) of children died, a third of whom had not started ART; 90% of children (n = 1990) started ART, at median age 5 months (IQR 1-16). Median follow-up from ART start was 26 months (IQR 14-40). Among children with available VL at 12 months (n = 853/1582), 24 months (n = 614/1129) and 36 months (n = 350/658) after ART start, 36%, 43% and 48% were virally suppressed, respectively (VL<100 copies/ml). VS among children at 12 and 24 months was more likely if maternal VL was <100 versus ≥100 copies/ml at 12 months (adjusted odds ratio [aOR] = 3.5; 95% CI 1.9-6.5) and 24 months (aOR = 6.1; 95% CI 2.8-13.1) after child ART start. Children with no/mild versus advanced/severe immunodeficiency at ART start were more likely to achieve VS at 12 months (aOR = 2.3; 95% CI 1.3-4.2) but not at 24 months. Eligible children with missing VL at 24 months (39%) were more likely to have gaps in care of >6 months than those with VL≥100 or VL<100 copies/ml (84% vs. 28% vs. 14%, respectively; p<0.001).
Conclusions:
Less than half of children on ART achieved VS, and children were more likely to achieve VS if their mothers were also virally suppressed. Significant efforts are needed to support mother-child dyads to achieve optimal VS.
