{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T15:56:38Z","timestamp":1788882998063,"version":"build-2803163510"},"reference-count":43,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"unspecified","delay-in-days":6,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,6,13]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Despite global improvements in antiretroviral therapy (ART) access for children and adolescents living with HIV (CALHIV), a significant proportion continue to experience unsuppressed viral load (USVL). Limited studies focus on the factors contributing to USVL among CALHIV in the Democratic Republic of the Congo (DRC), especially in the context of evolving treatment landscapes. Understanding these determinants is crucial for enhancing ART outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to determine the prevalence of USVL and identify factors associated with USVL among CALHIV receiving ART in Lubumbashi, DRC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A multicentre retrospective cross-sectional study was conducted. Data were gathered using an observational checklist based on assessing patient file data and entered into Microsoft Excel. Analysis was performed using STATA V.16. Variables with a p value of 0.20 from the bivariable analysis were included in a multivariable logistic regression model, and significant variables (p&lt;0.05) were retained in the final model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and participants<\/jats:title>\n                    <jats:p>The study was conducted at 21 HIV care clinics in Lubumbashi from June to September 2024. It included 847 CALHIV aged 0\u201319 years who had been on ART for at least 6\u2009months and had at least one available VL result.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measure<\/jats:title>\n                    <jats:p>The rate of USVL among CALHIV, defined as achieving a VL below 1000 copies\/mL, in those who had been on ART for at least 6 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of USVL among CALHIV was 24.68% (209\/847; 95%\u2009CI: 21.89% to 27.69%). Multivariable logistic regression analysis revealed that CALHIV with married caregivers were more likely to have USVL (adjsuted OR, aOR=2.4; 95%\u2009CI: 1.2 to 5.0). Other factors associated with USVL included horizontal HIV transmission (aOR=2.3; 95%\u2009CI: 1.0 to 5.2), advanced WHO clinical stages (aOR=3.5; 95%\u2009CI: 1.0 to 13.7), poor\/fair ART adherence (aOR=107.8; 95%\u2009CI: 50.3 to 231.1) and ART-induced side effects (aOR=3.8; 95%\u2009CI: 1.9 to 7.9).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The high rate of USVL among CALHIV in Lubumbashi highlights the need to strengthen ART adherence support, manage treatment side effects and improve early diagnosis and follow-up, particularly for those infected through horizontal transmission or presenting with advanced clinical stages. Special attention should also be given to caregiver-related factors, including marital status, which may influence treatment outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-094657","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T21:30:27Z","timestamp":1751923827000},"page":"e094657","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Prevalence and determinants of unsuppressed HIV viral loads among children and adolescents living with HIV on antiretroviral therapy in Lubumbashi, Democratic Republic of the Congo: a retrospective cross-sectional study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6902-7023","authenticated-orcid":false,"given":"Olivier","family":"Mukuku","sequence":"first","affiliation":[{"name":"Department of Maternal and Child Health, Institut Sup\u00e9rieur des Techniques M\u00e9dicales de Lubumbashi, Lubumbashi, Haut-Katanga, Congo (the Democratic Republic of the)"},{"name":"Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaymarlin","family":"Govender","sequence":"additional","affiliation":[{"name":"Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanislas Okitotsho","family":"Wembonyama","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Lubumbashi, Lubumbashi, Haut-Katanga, Congo (the Democratic Republic of the)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,7,7]]},"reference":[{"key":"2025120523543484000_15.7.e094657.1","unstructured":"World Health Organization . 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