Impact of a family-centered care model on viral suppression among HIV-infected children in Migori, Kenya

BACKGROUND: Viral suppression (VS) among children 2-9 years old receiving antiretroviral therapy (ART) in Kenya was 68.9% in 2018, substantially below the national trend of 95% by 2030. Kenya guidelines recommend differentiated service delivery (DSD) models and ART optimization to improve VS. In January 2018, University of Maryland Baltimore implemented a family-centered model (FCM), which included: family/caregiver treatment literacy sessions, engagement with peer educators, participation in psychosocial support groups, ART optimization, and linking patients to orphans and vulnerable child support programs. We assessed VS among children 2-9 years before and after FCM-implementation.
METHODS: We conducted a cross sectional analysis to assess VS among children receiving ART during the pre-FCM intervention period (September 2016-December 2017) and the post-FCM intervention period (December 2018-September 2020) at 8 UMB-supported facilities in Migori, Kenya. Routinely collected data were abstracted from standardized tools and registers. Generalized Estimating Equations, accounting for repeat measures from the same client, and a 6-month lag period from intervention implementation, were used to generate a multivariable logistic model to assess VS (<400 copies/ml) among children in the pre- and post-FCM intervention periods.
RESULTS: A total of 849 children (57% 6-9 years; 58% female) were included in the pre-FCM period, and 1336 (56% 6-9 years, 56% female) in the post-FCM period. At the time of VL testing in the pre-FCM period, 25% of clients were on Efavirenz(EFV), 42% on Nevirapine(NVP), 32% on Protease Inhibitors(PI) (i.e. ATV/r and LPV/r based regimens) and 1% in other regimens; while in the post-FCM period 7% were on Dolutegravir(DTG), 48% on EFV, 5% on NVP, 38% on PI, and 2% in other regimens. VS was 69% vs. 83% in the pre- and post-FCM periods, respectively(p<0.01). After adjusting for age and sex, children in the post-FCM period were 2-fold more likely to be virally suppressed compared to those in the pre-FCM period (aOR 95% CI 2.2 (1.7-2.7)).
CONCLUSIONS: VS was substantially higher among children 2-9 years of age who received the FCM intervention. Differentiated care models designed to better support both clients and their families can improve clinical outcomes among children living with HIV in resource-limited settings.