{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T15:11:48Z","timestamp":1777907508620,"version":"3.51.4"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,6,11]],"date-time":"2022-06-11T00:00:00Z","timestamp":1654905600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,6,11]],"date-time":"2022-06-11T00:00:00Z","timestamp":1654905600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/R010161\/1"],"award-info":[{"award-number":["MR\/R010161\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100020171","name":"Foreign, Commonwealth and Development Office","doi-asserted-by":"publisher","award":["MR\/R010161\/1"],"award-info":[{"award-number":["MR\/R010161\/1"]}],"id":[{"id":"10.13039\/501100020171","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pediatr"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>We investigated risk factors for sustained virological non-suppression (viral load\u2009\u2265\u20091000 copies\/ml on two tests 48\u00a0weeks apart) among children and adolescents accessing HIV care in public sector clinics in Harare, Zimbabwe and Blantyre, Malawi.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Participants were enrolled between 2016 and 2019, were aged 6\u201319\u00a0years, living with HIV, had chronic lung disease (FEV z-score\u2009&lt;\u2009-1) and had taken antiretroviral therapy (ART) for at least six months. We used multivariate logistic regression to identify risk factors for virological non-suppression after 48\u00a0weeks, among participants who were non-suppressed at enrolment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At enrolment 258 participants (64.6%) were on first-line ART and 152\/347 (43.8%) had virological non-suppression. After 48\u00a0weeks 114\/313 (36.4%) were non-suppressed. Participants non-suppressed at baseline had almost ten times higher odds of non-suppression at follow-up (OR\u2009=\u20099.9, 95%CI 5.3\u201318.4,<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Of those who were non-suppressed at enrolment, 87\/136 (64.0%) were still non-suppressed at 48\u00a0weeks. Among this group non-suppression at 48\u00a0weeks was associated with not switching ART regimen (adjusted OR\u2009=\u20095.55; 95%CI 1.41\u201321.83);<jats:italic>p<\/jats:italic>\u2009=\u20090.014) and with older age. Twelve participants switched regimen in Zimbabwe and none in Malawi.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Viral non-suppression was high among this group and many with high viral load were not switched to a new regimen, resulting in continued non-suppression after 48\u00a0weeks. Further research could determine whether improved adherence counselling and training clinicians on regimen switches can improve viral suppression rates in this population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration<\/jats:title><jats:p>Secondary cohort analysis of data from BREATHE trial (Clinicaltrials.gov<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT02426112\">NCT02426112<\/jats:ext-link>).<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12887-022-03400-4","type":"journal-article","created":{"date-parts":[[2022,6,11]],"date-time":"2022-06-11T09:02:47Z","timestamp":1654938167000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Risk factors for sustained virological non-suppression among children and adolescents living with HIV in Zimbabwe and Malawi: a secondary data analysis"],"prefix":"10.1186","volume":"22","author":[{"given":"Christi","family":"Jackson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea M.","family":"Rehman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Grace","family":"McHugh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carmen","family":"Gonzalez-Martinez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucky G.","family":"Ngwira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsitsi","family":"Bandason","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hilda","family":"Mujuru","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon O.","family":"Odland","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth L.","family":"Corbett","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rashida A.","family":"Ferrand","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Simms","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,6,11]]},"reference":[{"key":"3400_CR1","unstructured":"Ministry of Health and Child Care. Harare: 2019. Zimbabwe Population-Based HIV Impact Assessment (ZIMPHIA) 2015\u20132016. Final Report."},{"key":"3400_CR2","unstructured":"Ministry of Health and Child Care. Guidelines for antiretroviral therapy for the prevention and treatment of HIV in Zimbabwe. Harare: Zimbabwe Ministry of Health and Child Care; 2016"},{"key":"3400_CR3","volume-title":"Malawi guidelines for clinical management of HIV in children and adults","author":"Malawi Ministry of Health","year":"2016","unstructured":"Malawi Ministry of Health. Malawi guidelines for clinical management of HIV in children and adults. 3rd ed. Lilongwe: Malawi Ministry of Health; 2016.","edition":"3"},{"key":"3400_CR4","unstructured":"World Health Organisation. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach. 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S Afr J Fam Pract. 2020;62(1):a5169.","journal-title":"S Afr J Fam Pract"}],"container-title":["BMC Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12887-022-03400-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12887-022-03400-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12887-022-03400-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,7]],"date-time":"2023-02-07T22:59:36Z","timestamp":1675810776000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpediatr.biomedcentral.com\/articles\/10.1186\/s12887-022-03400-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,11]]},"references-count":24,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["3400"],"URL":"https:\/\/doi.org\/10.1186\/s12887-022-03400-4","relation":{},"ISSN":["1471-2431"],"issn-type":[{"value":"1471-2431","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,11]]},"assertion":[{"value":"29 January 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 May 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 June 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All methods were performed in accordance with the Declaration of Helsinki. The study was approved by the Malawi College of Medicine research ethics committee (P.04\/15\/1719), the Medical Research Council of Zimbabwe, the Biomedical Research and Training Institute institutional review board in Zimbabwe (Ref AP132\/2015), the London School of Hygiene & Tropical Medicine ethics committee (Ref 8818\u20134), the University of Cape Town research ethics committee, and the Regional Ethics Committee for Medical and Health Research in Norway. Written informed consent was obtained from the parent or guardian of all participants younger than 18\u00a0years. Age-appropriate assent was obtained from participants younger than 18\u00a0years. Participants aged 18\u00a0years and above gave informed consent independently.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"340"}}