Follow-up Outcomes of Children, Adolescents and Young People on Darunavir-Based Third-line Antiretroviral Therapy - Observational Cohort from Nine African Countries.

BACKGROUND: We assessed clinical outcomes among children, adolescents and young people (< 25 years) on darunavir-based antiretroviral therapy (ART) in nine sub-Saharan African countries. SETTING: Third-line ART centers in Cameroon, Eswatini, Kenya, Lesotho, Nigeria, Rwanda, Uganda, Zambia and Zimbabwe. METHODS: From January 2019 to December 2022, we collected data from a cohort of children, adolescents and young people receiving third-line ART from 9 sub-Saharan African countries. Data on treatment continuity, viral suppression, death and clinic transfers were extracted from medical records and summarized. Cox proportional hazards models were used to identify factors independently associated with retention in care. RESULTS: Of 871 participants enrolled, median age 14.8 (range: 0.2 - 24.7) years, 488 (56.0%) male; 809 (92.9%) [median duration of follow-up of 28.3 months (IQR:17.5 - 45.2)] had final outcomes after initiating third-line ART. Of these, 711 (87.9%) were alive and in care at the end of study follow-up, 29 (3.6%) died, 30 (3.7%) transferred to other facilities, and 39 (4.8%) were lost to follow-up. Retention in care was less likely among males compared to females (aHR: 0.85, 95%CI 0.72-1.0), and in 10-14-year-olds compared to younger children. Adolescents (15-19 years) had higher mortality compared to children <10 years of age (aSHR: 4.20, 95% CI 1.37-12.87). Viral suppression was seen in 345/433 (79.7%), 249/320 (77.8%), and 546/674 (81.0%) patients with results at 6, 12 months and study end, respectively. CONCLUSION: A high proportion of children and young people receiving third-line ART in Sub-Saharan Africa, remain in care, and attain viral suppression during follow-up.

Comparison of HIV prevalence, incidence, and viral load suppression in Zambia population-based HIV impact assessments from 2016 and 2021.

BACKGROUND: The Zambian government has implemented a public health response to control the HIV epidemic in the country. Zambia conducted a population-based HIV impact assessment (ZAMPHIA) survey in 2021 to assess the status of the HIV epidemic to guide its public health programs. METHODS: ZAMPHIA 2021 was a cross-sectional two-stage cluster sample household survey among persons aged ≥15 years conducted in Zambia across all 10 provinces. Consenting participants were administered a standardized questionnaire and whole blood was tested for HIV according to national guidelines. HIV-1 viral load (VL), recent HIV infection, and antiretroviral medications were tested for in HIV-seropositive samples. Viral load suppression (VLS) was defined as <1000 copies/ml. ZAMPHIA 2021 results were compared to ZAMPHIA 2016 for persons aged 15-59 years (i.e., the overlapping age ranges). All estimates were weighted to account for nonresponse and survey design. RESULTS: During ZAMPHIA 2021, of 25 483 eligible persons aged ≥15 years, 18 804 (73.8%) were interviewed and tested for HIV. HIV prevalence was 11.0% and VLS prevalence was 86.2% overall, but was <80% among people living with HIV aged 15-24 years and in certain provinces. Among persons aged 15-59 years, from 2016 to 2021, HIV incidence declined from 0.6% to 0.3% ( P -value: 0.07) and VLS prevalence increased from 59.2% to 85.7% ( P -value: <0.01). DISCUSSION: Zambia has made substantial progress toward controlling the HIV epidemic from 2016 to 2021. Continued implementation of a test-and-treat strategy, with attention to groups with lower VLS in the ZAMPHIA 2021, could support reductions in HIV incidence and improve overall VLS in Zambia.