{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T02:30:38Z","timestamp":1784341838647,"version":"3.55.0"},"reference-count":32,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2021,5,13]],"date-time":"2021-05-13T00:00:00Z","timestamp":1620864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>With scale\u2010up of antiretroviral therapy (ART) children, treatment failure and switch to subsequent ART regimens are common. Our objectives were to evaluate switching practices and identify factors associated among children and adolescents failing their first\u2010line ART.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A facility\u2010based survey study was conducted in a cohort of children living with HIV experiencing virological failure (VF) at the Essos Hospital Centre of Yaounde, Cameroon. Data were collected using a standard questionnaire, and key variables were as follows: (a) VF defined as viral load (VL)\u00a0&gt;\u00a01000 copies\/ml, (b) rate of switch to second\u2010line and (c) reason(s) for switching ART. Odds ratio (OR) with 95% confidence interval (CI) was used to assess the association between study variables, and <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.05 was considered statistically significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 106 children experiencing VF were enrolled: median age was 8 [interquartile range (IQR): 3\u201315] years; 60.38% were boys and 39.62% were orphans of one\/both parents. A proportion of 69% were at the WHO clinical stage III\/IV, and 13.21% were experiencing immunological failure (CD4\u00a0&lt;\u00a0200 cells\/mm<jats:sup>3<\/jats:sup>). The median duration on first\u2010line ART was 36 [IQR: 7\u2013157] months prior to detecting VF, and the rate of switch to second\u2010line ART was 70.75% (75\/106). Delay in switching ART after a confirmed VF was 11 [IQR: 7\u201316] months. After switch to second\u2010line ART, the median time to achieve undetectable VL (&lt;40\u00a0copies\/ml) was 14 [IQR: 9\u201321] months. Multivariate analysis revealed that only children with viral rebound (aOR\u00a0=\u00a00.09; 95% CI\u00a0=\u00a00.03\u20130.24) were less likely to be switched. Of note, being orphaned (aOR\u00a0=\u00a00.35, CI\u00a0=\u00a00.11\u20131.11), biological sex (aOR\u00a0=\u00a01.77, CI\u00a0=\u00a00.60\u20135.29) and immune status (aOR\u00a0=\u00a00.19, CI\u00a0=\u00a00.03\u20131.31, 0.09) had no significant effect on switching to second\u2010line ART.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this paediatric population experiencing VF after about 3\u20134\u00a0years from ART initiation, the majority are switched to second\u2010line ART after a delay of almost one year. Delayed switch to second\u2010line was driven essentially by viral rebound, underscoring the need for close viral monitoring.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.13595","type":"journal-article","created":{"date-parts":[[2021,4,27]],"date-time":"2021-04-27T18:16:15Z","timestamp":1619547375000},"page":"927-935","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Determinants of switch to paediatric second\u2010line antiretroviral therapy after first\u2010line failure in Cameroon"],"prefix":"10.1111","volume":"26","author":[{"given":"Anne\u2010Esther","family":"Njom\u2010Nlend","sequence":"first","affiliation":[{"name":"Essos Hospital Centre National Social Insurance Fund Hospital Yaound\u00e9 Cameroon"},{"name":"Higher Institute of Medical Technology University of Douala Yaound\u00e9 Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nad\u00e8ge","family":"Efouba","sequence":"additional","affiliation":[{"name":"Higher Institute of Medical Technology University of Douala Yaound\u00e9 Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ars\u00e8ne","family":"Brunelle Sandie","sequence":"additional","affiliation":[{"name":"Pan African University Nairobi Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Fokam","sequence":"additional","affiliation":[{"name":"Chantal BIYA International Reference Centre for Research on HIV\/AIDS Prevention and Management Yaounde Cameroon"},{"name":"Faculty of Health Sciences University of Buea Buea Cameroon"},{"name":"Faculty of Medicine and Biomedical Sciences University of Yaounde I Yaounde Cameroon"},{"name":"National HIV Drug Resistance Working Group Ministry of Public Health Yaounde Cameroon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,5,13]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"UNAIDS Data report 2018. 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