BACKGROUND: Although achieving viral load suppression (VLS) remains the primary objective of HIV treatment, a challenge persists in sustaining it over the course of patients' lives for their well-being. This study evaluated the extent of viral rebound and their associated factors among orphaned and vulnerable children (OVC) aged 0-17 years receiving antiretroviral therapy (ART) in Tanzania.
METHODS: The study is based on data from a community-based USAID-funded Adolescents and Children HIV Incidence Reduction, Empowerment, and Virus Elimination (ACHIEVE) project in Tanzania. Focusing on HIV positive OVC, on ART, and receiving community-based complementary support from the ACHIEVE project, OVC with at least two clinically confirmed viral load tests spaced at least 6 months apart between 2021 and 2023 with the first test indicating that they were virally undetectable (viral load <50 copies/mL) were included in the analysis. Viral rebound was defined as viral load =50 copies/mL at the second test. Data analysis involved multivariable mixed-effects effects logistic regression.
RESULTS: Out of 21,448 CLHIV (52.4% female) aged 10.8 years on average and virally undetectable at baseline, 86.9% (n = 18,643) maintained their undetectable status at the follow-up (second test), and 13.1% (n = 2,805) experienced viral rebound. In the regression analysis, various project interventions were associated with lower risk of viral rebound among the OVC, and the significant ones were teen club attendance (aOR = 0.60, 95% CI 0.51-0.70), and health insurance (aOR = 0.76, 95% CI 0.69-0.84). On the other hand, viral rebound was higher among OVC on regimens other than DTG (aOR = 1.37, 95% CI 1.10-1.70), attending school (aOR = 1.14, 95% CI 1.03-1.27), residing in urban areas (aOR = 1.20, 95% CI 1.10-1.31), and had caregivers with primary education (aOR = 1.19, 95% CI 1.06-1.34) and secondary education (aOR = 1.33, 95% CI 1.06-1.65).
CONCLUSIONS: Although 13.1% of the OVC experienced viral rebound at the follow-up, the ACHIEVE project interventions showed promise to reduce the problem. Additional support is needed especially by those at an elevated risk of rebound, including those on regimens different from DTG, attending school, residing in urban areas, and having caregivers with primary, secondary, or higher education levels.