Evidence of reduced treatment adherence among HIV infected paediatric and adolescent populations in Nairobi at the onset of the UNAIDS Universal Test and Treat Program

• Published in: BMC research notes Vol. 11; no. 1; p. 134
• Main Authors: Kabogo, Joseph, Muniu, Erastus, Wamunyokoli, Fred, Musoke, Rachel, Songok, Elijah
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 17.02.2018; BioMed Central; BMC
• Subjects: 90-90-90; Acquired immune deficiency syndrome; Adherence; Adolescent; Age groups; AIDS; Analysis; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral therapy; Care and treatment; Caregivers; Child; Child, Preschool; Children; Cohort analysis; Comparative analysis; Confidence intervals; Drug therapy; Female; Health aspects; HIV; HIV Infections - drug therapy; HIV Infections - ethnology; Human immunodeficiency virus; Humans; Infant; Kenya; Male; Medication Adherence - ethnology; Outcome Assessment (Health Care); Patient compliance; Patients; Pediatrics; Program Development; Research Note; Retrospective Studies; Risk factors; Teenagers; United Nations; Universal test and treat; World Health Organization; Kenya; Nairobi Kenya; Adherence; HIV; Virologic failure; 90-90-90; Children; Universal test and treat; Kenya; Antiretroviral therapy
• ISSN: 1756-0500; 1756-0500
• DOI: 10.1186/s13104-018-3205-0

We conducted a retrospective cohort study to evaluate the efficacy of the World Health Organization (WHO) "Universal Test and Treat" (UTT) policy, initiated in Kenya in September 2016. Under this policy, every human immunodeficiency virus (HIV)-infected person should be initiated on antiretroviral therapy (ART). We compared intra- and inter-group viral suppression and ART adherence rates for pre-UTT (initiated on ART in March-August 2016) and UTT groups (initiated in September 2016). The study was conducted in a community outreach Program in Nairobi with 3500 HIV-infected children enrolled. 122 children and adolescents were initiated on first-line ART pre-UTT, and 197 during the UTT period. The 6 month viral suppression rate was 79.7% pre-UTT versus 76.6% UTT (P < 0.05). Suboptimal adherence was higher in the UTT than pre-UTT period (88 of 197, 44.7% and 44 of 122, 34%; P < 0.001). The decrease in adherence was greater among orphans (91.7% pre-UTT and 87.2% UTT, P = 0.001) and children 11-18 years. Our results show that successful implementation of the UTT policy in Africa is challenged by an increased risk of suboptimal adherence. There is a need to develop extra strategies to support adherence, especially among orphans and teenagers.