High rate of loss to follow-up and virological non-suppression in HIV-infected children on antiretroviral therapy highlights the need to improve quality of care in South Africa

Genevieve A. F. S. van Liere, Rivka Lilian, Jackie Dunlop*, Carol Tait, Kate Rees, Moya Mabitsi, Lucy Ranoto, Helen E. Struthers, James A. McIntyre, Remco P. H. Peters

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Provision of high-quality care and ensuring retention of children on antiretroviral therapy (ART) are essential to reduce human immunodeficiency virus (HIV)-associated morbidity and mortality. Virological non-suppression (>= 1000 viral copies/ml) is an indication of suboptimal HIV care and support. This retrospective cohort study included ART-naive children who initiated first-line ART between July 2015 and August 2017 in Johannesburg and rural Mopani district. Of 2739 children started on ART, 29.5% (807/2739) were lost to care at the point of analysis in August 2018. Among retained children, overall virological non-suppression was 30.2% (469/1554). Virological non-suppression was associated with higher loss to care 30.3% (229/755) compared with suppressed children (9.7%, 136/1399, P < 0.001). Receiving treatment in Mopani was associated with virological non-suppression in children under 5 years (adjusted odds ratio (aOR) 1.7 (95% confidence interval (CI) 1.1-2.4), 5-9 years (aOR 1.8 (1.1-3.0)) and 10-14 years (aOR 1.9 (1.2-2.8)). Virological non-suppression was associated with lower CD4 count in children 5-9 years (aOR 2.1 (1.1-4.1)) and 10-14 years (aOR 2.1 (1.2-3.8)). Additional factors included a shorter time on ART (

Original languageEnglish
Article number88
Number of pages8
JournalEpidemiology and Infection
Publication statusPublished - 22 Mar 2021



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