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We conducted a secondary analysis using data from a randomized control trial for ART monitoring among CLHIV in Kisumu County, Kenya from 2019 to 2023, to assess clinical, psychosocial, and structural factors associated with HIV DR. Methods: 704 CLHIV were followed for 12+ months, with characteristics captured at enrollment and follow-up visits in the \u201cparent\u201d randomized-controlled-trial (of point-of-care plasma viral load testing and for viremias \u2265 1000 copies\/mL HIV genotyping for DR vs. standard-of-care) and an observational \u201cextension\u201d substudy (of participants on a dolutegravir-containing ART with genotyping performed on viremic specimens \u2265 200 copies\/mL). A multivariate modified Poisson regression model was used to analyze factors associated with sequences yielding a Stanford HIVDR database DR penalty score (DR-PS) \u2265 30 to a nucleos(t)ides and\/or non-nucleoside reverse transcriptase inhibitor, protease inhibitor (PI), and\/or integrase inhibitor (INSTI). Results: Among 113 (16.1%) participants who underwent genotyping, 93 (82.3%) had a DR-PS \u2265 30. DR-PS \u2265 30 were associated with age 1\u20135 years (adjusted risk ratio (ARR) = 1.84; 95% confidence interval (CI): 1.07, 3.14), history of viremia \u2265 1000 copies\/mL (ARR = 4.18; 95% CI: 2.77, 6.31), prescription of a PI- (ARR = 6.05; 95% CI: 3.43, 10.68) or INSTI-containing regimen (ARR = 1.83; 95% CI: 1.08, 3.11), poor adherence to ART (ARR = 1.91; 95% CI: 1.32, 2.76), lack of caregiver confidence in ART administration (ARR = 1.89; 95% CI: 1.11, 3.22), and mid-sized clinic populations (ARR = 0.55; 95% CI: 0.33, 0.92). Conclusion: Addressing social factors associated with DR-PS \u2265 30 may improve ART success among CLHIV.<\/jats:p>","DOI":"10.3390\/v17091246","type":"journal-article","created":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T11:19:31Z","timestamp":1758021571000},"page":"1246","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical, Psychosocial, and Structural Factors Associated with the Detection of HIV Drug Resistance in Children Living with HIV in Kisumu, Kenya: Secondary Analysis of Data from the Opt4Kids Study"],"prefix":"10.3390","volume":"17","author":[{"given":"Andrea J.","family":"Scallon","sequence":"first","affiliation":[{"name":"Elson S. Floyd College of Medicine, Washington State University, Spokane, WA 99202, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8462-9323","authenticated-orcid":false,"given":"Pooja","family":"Maheria","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Oyaro","sequence":"additional","affiliation":[{"name":"Health Innovations Kenya (HIK), Kisumu 40100, Kenya"},{"name":"LVCT Health, Nairobi 00202, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine K.","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington, Seattle, WA 98105, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2125-6799","authenticated-orcid":false,"given":"Bhavna H.","family":"Chohan","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington, Seattle, WA 98105, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Odhiambo","sequence":"additional","affiliation":[{"name":"Centre for Microbiology Research, Research Care and Training Program, Kenya Medical Research Institute, Nairobi 00200, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelyn","family":"Brown","sequence":"additional","affiliation":[{"name":"UW Kenya, Nairobi 00200, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0180-3369","authenticated-orcid":false,"given":"Edwin","family":"Ochomo","sequence":"additional","affiliation":[{"name":"Centre for Microbiology Research, Research Care and Training Program, Kenya Medical Research Institute, Nairobi 00200, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enericah","family":"Karauki","sequence":"additional","affiliation":[{"name":"UW Kenya, Nairobi 00200, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nashon","family":"Yongo","sequence":"additional","affiliation":[{"name":"UW Kenya, Nairobi 00200, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shukri A.","family":"Hassan","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Washington, Seattle, WA 98105, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marley D.","family":"Bishop","sequence":"additional","affiliation":[{"name":"Center for Global Infectious Disease Research, Seattle Children\u2019s Research Institute, Seattle, WA 98101, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid A.","family":"Beck","sequence":"additional","affiliation":[{"name":"Center for Global Infectious Disease Research, Seattle Children\u2019s Research Institute, Seattle, WA 98101, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ceejay","family":"Boyce","sequence":"additional","affiliation":[{"name":"Center for Global Infectious Disease Research, Seattle Children\u2019s Research Institute, Seattle, WA 98101, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9566-8959","authenticated-orcid":false,"given":"Lisa M.","family":"Frenkel","sequence":"additional","affiliation":[{"name":"Department of Global Health, University of Washington, Seattle, WA 98105, USA"},{"name":"Department of Medicine, University of Washington, Seattle, WA 98105, USA"},{"name":"Center for Global Infectious Disease Research, Seattle Children\u2019s Research Institute, Seattle, WA 98101, USA"},{"name":"Department of Pediatrics, University of Washington, Seattle, WA 98105, USA"},{"name":"Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA 98195, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1492-5090","authenticated-orcid":false,"given":"Lisa","family":"Abuogi","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Colorado, Denver, CO 80045, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9893-5856","authenticated-orcid":false,"given":"Rena C.","family":"Patel","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, USA"},{"name":"Department of Global Health, University of Washington, Seattle, WA 98105, USA"},{"name":"Department of Medicine, University of Washington, Seattle, WA 98105, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,16]]},"reference":[{"key":"ref_1","unstructured":"UNICEF (2025, August 18). 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