Prevalence and factors associated with virological failure in children and adolescents on second line antiretroviral treatment at Lira Regional Referral Hospital

Abstract

Background - In 2024, 1.4 million children under the age of 15years had HIV, with 120,000 having acquired the infection that year. By December 2023, an estimated 1.49 million people had HIV in Uganda, including 72,000 children aged 0-14 years. Antiretroviral therapy has significantly improved the survival and quality of life for children with HIV, but treatment failure remains a major obstacle, particularly among children. Viral load suppression in HIV-positive children is still only 60%, compared to 79% in adults. Factors contributing to virological failure include poor adherence to treatment, age, weight, type of regimen, duration on first-line treatment and many more. The high pill burden of third-line treatment regimens poses challenges for children who fail on second-line. Objectives - To determine the prevalence and factors associated with virological failure among children and adolescents on second line HIV treatment at Lira RRH. Methods – This was a cross-sectional study. Dependent variable was prevalence of virological failure and independent variables included patient demographics, medical and social factors. Results - The majority of the participants were adolescents 196 (97.51%) with a median age (IQR) of 16 yrs (14,18). There was an almost equal number of male and female participants with the males 103(51.24%) just slightly over half. The majority of participants were in school 146(72.6%) and just over half 103(51.2%) had both parents alive. Parents were the primary caregivers for 118(51.7%) of participants. A majority of caregivers 148(73.6%) were HIV positive. the median duration on ART was 87 months. Majority, 187(93.0%) were on a Nevirapine/Efavirenz-based first-line regimen. Over half 116(57.7%) had never been lost to follow-up, and 116(82.6%) self-administered ART. Most participants 196(97.5%) had no other chronic illnesses. The prevalence of virological failure was 19%(38/201) with a 95% confidence interval of 14-25%. Adherence score of < 95% was positively associated with virological failure (AOR-11, 95% CI 3.5-34.3, P value <0.001). Conclusion – Virological failure remains a major problem among children and adolescents on second line ART, with suboptimal adherence being positively associated. These findings highlight the need for targeted interventions to improve adherence in the paediatric population.