Impact of ARV optimization on HIV viral load suppression among children in Tanzania

BACKGROUND: Tanzania adopted the WHO recommendation to optimize pediatric antiretroviral therapy (ART) using a lopinavir-boosted ritonavir (LPV/r)-based or a dolutegravir (DTG)-based regimen. The Elizabeth Glaser Pediatric AIDS Foundation supported the transition to optimized regimen by using pediatric mentors to build capacity of multi-disciplinary teams to conduct routine pediatric case file reviews and we evaluated the impact on HIV viral load suppression.
METHODS: A retrospective cross-sectional review of program data from five supported regions was conducted to analyze the progress of transition to optimal ART regimens and HVL suppression in children aged 0-14 years, over a three-year period, January 2018-December 2020. Export for analysis data were extracted from electronic care and treatment (CTC2) databases across 325 health facilities from five supported regions. HVL suppression was determined using the latest HVL measure within the calendar year.
RESULTS: The number and proportion of children on optimal regimen increased from 392 children (9%) by June 2018 to 4,052 children (87%) by June 2020, including 1,350 children (29%) who are on LPV/r-based regimen. Within the same period, the HVL suppression rate among children increased from 60% to 83%, whereby an improvement is seen across all regimens, including the sub-optimal NVP and EFV-based regimens. However, the HVL suppression rate among children using LPV/r-based regimen had a relatively low increase from 66% to 76%, compared to 89% among children on DTG based regimen, as shown in the figure below.


CONCLUSIONS: While the transition to optimal pediatric ART regimens is making progress, and subsequently resulting in a steady increase of HVL suppression among children, there are concerns with the low HVL suppression among children using LPV/r-based regimen, which till date does not yet outperform the sub-optimal EFV-based regimen. There is need to assess the availability and administration of pediatric formulations of LPV/r-based regimen to ensure children reach viral suppression.