{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T13:23:17Z","timestamp":1787491397051,"version":"build-2736575974"},"reference-count":26,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100010877","name":"ViiV Healthcare","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010877","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01HD080465"],"award-info":[{"award-number":["R01HD080465"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01AI069924"],"award-info":[{"award-number":["U01AI069924"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Globally, children living with HIV continue to lag behind UNAIDS targets for viral suppression (VS). Because studies with linked mother\u2010child data are limited, we describe VS and associated factors among young children in a setting with early infant HIV testing (at birth, age 10 weeks and 6 months) and early protease inhibitor\u2010based first\u2010line antiretroviral therapy (ART).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed routinely collected mother\u2010child data for children living with HIV born 2018\u20132022 in Western Cape province, South Africa (followed through mid\u20102023). We assessed associations between child and maternal viral load (VL) results at 12 and 24 months after child ART start using logistic regression, adjusted for child sex, birthyear, severity of child immunodeficiency at ART start, maternal age and timing of maternal HIV diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 2219 children living with HIV; 30% were diagnosed at birth (\u22647 days), 41% before age 1 year (8\u2212365 days) and 29% at age &gt;1 year. Overall, 5% (\n                      <jats:italic>n<\/jats:italic>\n                      = 112\/2219) of children died, a third of whom had not started ART; 90% of children (\n                      <jats:italic>n<\/jats:italic>\n                      = 1990) started ART, at median age 5 months (IQR 1\u201316). Median follow\u2010up from ART start was 26 months (IQR 14\u201340). Among children with available VL at 12 months (\n                      <jats:italic>n<\/jats:italic>\n                      = 853\/1582), 24 months (\n                      <jats:italic>n<\/jats:italic>\n                      = 614\/1129) and 36 months (\n                      <jats:italic>n<\/jats:italic>\n                      = 350\/658) after ART start, 36%, 43% and 48% were virally suppressed, respectively (VL&lt;100 copies\/ml). VS among children at 12 and 24 months was more likely if maternal VL was &lt;100 versus \u2265100 copies\/ml at 12 months (adjusted odds ratio [aOR] = 3.5; 95% CI 1.9\u22126.5) and 24 months (aOR = 6.1; 95% CI 2.8\u221213.1) after child ART start. Children with no\/mild versus advanced\/severe immunodeficiency at ART start were more likely to achieve VS at 12 months (aOR = 2.3; 95% CI 1.3\u22124.2) but not at 24 months. Eligible children with missing VL at 24 months (39%) were more likely to have gaps in care of &gt;6 months than those with VL\u2265100 or VL&lt;100 copies\/ml (84% vs. 28% vs. 14%, respectively;\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Less than half of children on ART achieved VS, and children were more likely to achieve VS if their mothers were also virally suppressed. Significant efforts are needed to support mother\u2010child dyads to achieve optimal VS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.26418","type":"journal-article","created":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T02:22:10Z","timestamp":1738290130000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Mother\u2010child dyads living with HIV in the Western Cape, South Africa: Undetectable = Undetectable?"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2453-6219","authenticated-orcid":false,"given":"Kim","family":"Anderson","sequence":"first","affiliation":[{"name":"Centre for Integrated Data and Epidemiological Research, School of Public Health, Faculty of Health Sciences, University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Rabie","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health Stellenbosch University and Tygerberg Hospital  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian S.","family":"Eley","sequence":"additional","affiliation":[{"name":"Paediatric Infectious Diseases Unit Department of Paediatrics and Child Health Red Cross War Memorial Children's Hospital University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4097-3128","authenticated-orcid":false,"given":"Lisa","family":"Frigati","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health Stellenbosch University and Tygerberg Hospital  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Nuttall","sequence":"additional","affiliation":[{"name":"Paediatric Infectious Diseases Unit Department of Paediatrics and Child Health Red Cross War Memorial Children's Hospital University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7706-6866","authenticated-orcid":false,"given":"Emma","family":"Kalk","sequence":"additional","affiliation":[{"name":"Centre for Integrated Data and Epidemiological Research, School of Public Health, Faculty of Health Sciences, University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexa","family":"Heekes","sequence":"additional","affiliation":[{"name":"Health Intelligence, Western Cape Department of Health and Wellness  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gayathri","family":"Sridhar","sequence":"additional","affiliation":[{"name":"ViiV Healthcare  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leigh","family":"Ragone","sequence":"additional","affiliation":[{"name":"ViiV Healthcare  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0157-9689","authenticated-orcid":false,"given":"Vani","family":"Vannappagari","sequence":"additional","affiliation":[{"name":"ViiV Healthcare  Durham North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Mudaly","sequence":"additional","affiliation":[{"name":"Western Cape Department of Health and Wellness Service Priorities Coordination  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Boulle","sequence":"additional","affiliation":[{"name":"Centre for Integrated Data and Epidemiological Research, School of Public Health, Faculty of Health Sciences, University of Cape Town  Cape Town South Africa"},{"name":"Health Intelligence, Western Cape Department of Health and Wellness  Cape Town South Africa"},{"name":"Division of Public Health Medicine School of Public Health, Faculty of Health Sciences, University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8496-6475","authenticated-orcid":false,"given":"Mary\u2010Ann","family":"Davies","sequence":"additional","affiliation":[{"name":"Centre for Integrated Data and Epidemiological Research, School of Public Health, Faculty of Health Sciences, University of Cape Town  Cape Town South Africa"},{"name":"Health Intelligence, Western Cape Department of Health and Wellness  Cape Town South Africa"},{"name":"Division of Public Health Medicine School of Public Health, Faculty of Health Sciences, University of Cape Town  Cape Town South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,1,30]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"UNAIDS.Epidemic and response: people living with HIV\u2014children (0\u201314); & new HIV infections\u2014children (0\u201314) in 2023 [Internet].2024. Available from:https:\/\/aidsinfo.unaids.org\/"},{"key":"e_1_2_11_3_1","unstructured":"UNAIDS.Transforming vision into reality: the 2024 Global Alliance Progress Report on Ending AIDS in Children by 2030 [Internet].2024[cited 2024 Nov 22]. Available from:https:\/\/www.unaids.org\/en\/resources\/documents\/2024\/transforming\u2010vision\u2010into\u2010reality"},{"key":"e_1_2_11_4_1","unstructured":"MazanderaniAH ShermanGG.Paediatric & adolescent HIV viral load monitoring 2014\u20132020.National Institute for Communicable Diseases of South Africa Bulletin;2021."},{"key":"e_1_2_11_5_1","unstructured":"UNICEF.Understanding and improving viral load suppression in children with HIV in Eastern and Southern Africa [Internet].2021. 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Available from:https:\/\/sahivsoc.org\/Files\/ARTGuidelines15052015.pdf"},{"key":"e_1_2_11_11_1","unstructured":"World Health Organization.WHO case definitions of HIV for surveillance and revised clinical staging and immunological classification of HIV\u2010related disease in adults and children [Internet].2007. Available from:https:\/\/apps.who.int\/iris\/handle\/10665\/43699"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.26235"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.4102\/sajhivmed.v22i1.1278"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.26191"},{"key":"e_1_2_11_15_1","unstructured":"National Department of Health Republic of South Africa.2023 ART clinical guidelines for the management of HIV in adults pregnancy and breastfeeding adolescents children infants and neonates [Internet].2023. 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