{ "abstract": "Background\n\nKenya has expanded antiretroviral therapy (ART) coverage and improved viral suppression among children living with HIV (CLHIV). However, low-level viraemia (LLV) and clinical or programmatic factors may increase the risk of virologic failure (VF) and HIV drug resistance, threatening long-term treatment outcomes. We estimated LLV prevalence and its association with virologic outcomes among CLHIV in Kenya, along with other relevant factors.Methods\n\nWe conducted a retrospective analysis using data from Kenya's national HIV program database (2017-2023) for CLHIV aged 0-14 years on ART for ≥24 weeks with plasma-based viral load (VL) results. VL categories were undetectable VL (UVL; ≤50 copies/mL), LLV (51-999 copies/mL), and viral load non-suppression (VLNS; ≥1000 copies/mL). We assessed LLV prevalence and associations between initial VL and other factors with subsequent VLNS and VF (≥2 consecutive VLNS results) using non-time dependent and time-dependent multivariable models.Findings\n\nAmong 59,879 records, median age at initial VL was 7.6 years (IQR 4.2-11.3); 61.0% (36,524) had UVL, 20.6% (12,336) had LLV (51-199 copies/mL, 11.5% [6885]; 200-399 copies/mL, 4.7% [2785]; 400-999 copies/mL, 4.5% [2666]), and 18.4% (11,019) had VLNS. Across all VLs, 73.2% (43,843) achieved UVL, 29.7% (17,755) had LLV, and 4.4% (2614) experienced VF. Initial LLV increased risk of VLNS (adjusted relative risk [aRR] 1.87, 95% CI, 1.73-2.02) and VF (aRR 2.53, 95% CI, 2.03-3.15), highest at 400-999 copies/mL (VLNS aRR 2.64, 95% CI, 2.36-2.95); VF aRR 3.36, 95% CI, 2.46-4.59). Younger children (5-9 years) and those receiving dolutegravir-based ART had lower risk, while CLHIV in the Coast region had higher risk.Interpretation\n\nThese findings highlight the importance of timely viral load monitoring, practical adherence support interventions, and appropriate regimen review to address LLV in CLHIV and achieve sustained virologic suppression.Funding\n\nThis project was supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC).", "abstract_shown": true, "affiliations": [ "U.S. Centers for Disease Control and Prevention (CDC), Global Health Center, Division of Global HIV&TB, Nairobi, Kenya.", "U.S. Centers for Disease Control and Prevention (CDC), Global Health Center, Division of Global HIV&TB, Atlanta, GA, USA.", "Clinton Health Access Initiative, Nairobi, Kenya.", "U.S. Embassy Nairobi, Office of Foreign Assistance, Kenya.", "Ministry of Health Kenya, Division of Community Health, Nairobi, Kenya.", "Ministry of Health Kenya, National AIDS and STI Control Program, Nairobi, Kenya.", "Ministry of Health Kenya, National Public Health Laboratory, Nairobi, Kenya.", "U.S. Centers for Disease Control and Prevention (CDC), Global Health Center, Division of Global HIV&TB, Pretoria, South Africa." ], "article_type": "research article", "arxiv": null, "author_total": 20, "authors": [ { "affs": [ 0 ], "name": "Appolonia Aoko" }, { "affs": [ 1 ], "name": "Sherri Pals" }, { "affs": [ 0 ], "name": "Susan Gachau" }, { "affs": [ 0 ], "name": "Lennah Omoto" }, { "affs": [ 0 ], "name": "Immaculate Mutisya" }, { "affs": [ 1 ], "name": "Bianca Alvarez" }, { "affs": [ 0 ], "name": "Kenneth Masamaro" }, { "affs": [ 0 ], "name": "Evelyn Ngugi" }, { "affs": [ 0 ], "name": "Frank Basiye" }, { "affs": [ 0 ], "name": "Cathy Toroitich-Ruto" }, { "affs": [ 2 ], "name": "Timothy Ngugi" }, { "affs": [ 3 ], "name": "Peter Yegon" }, { "affs": [ 4 ], "name": "Maureen Kimani" }, { "affs": [ 5 ], "name": "Lilly Nyagah" }, { "affs": [ 5 ], "name": "Lazarus Momanyi" }, { "affs": [ 5 ], "name": "Barbara Mambo" }, { "affs": [ 6 ], "name": "Nancy Bowen" }, { "affs": [ 3 ], "name": "Salome Okutoyi" }, { "affs": [ 7 ], "name": "Rachael Joseph" }, { "affs": [ 1 ], "name": "Helen M Chun" } ], "bibtex": "https://research.draconitic.com/paper/299vmy52j0arm.bib", "cited_by": 0, "doi": "10.1016/j.lanafr.2026.100038", "fulltext_url": "https://europepmc.org/articles/PMC13711272", "id": "299vmy52j0arm", "issns": [ "3050-5011" ], "landing_url": "https://europepmc.org/article/MED/42948502", "language": "eng", "licence": "CC-BY-NC", "licence_label": "CC BY-NC", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "Article" ], [ "openalex", "2725|HIV/AIDS Research and Interventions" ] ], "openalex": "W7140179909", "pdf_url": "https://europepmc.org/articles/PMC13711272?pdf=render", "pmcid": "PMC13711272", "pmid": "42948502", "published": "2026-07-01", "publisher": null, "ris": "https://research.draconitic.com/paper/299vmy52j0arm.ris", "sources": [ { "first_seen": "2026-10-31T00:20:36Z", "native_id": "MED:42948502", "source": "europepmc", "url": "https://europepmc.org/article/MED/42948502" }, { "first_seen": "2026-10-31T12:22:04Z", "native_id": "PMC13711272", "source": "pmc", "url": "https://doi.org/10.1016/j.lanafr.2026.100038" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2725|HIV/AIDS Research and Interventions", "subfield": "infectious-disease" } ], "title": "Low-level viraemia and other factors associated with virologic outcomes among children living with HIV on antiretroviral therapy in Kenya, 2017-2023: a retrospective longitudinal analysis.", "title_text": "Low-level viraemia and other factors associated with virologic outcomes among children living with HIV on antiretroviral therapy in Kenya, 2017-2023: a retrospective longitudinal analysis.", "type": "peer-reviewed", "updated_at": "2026-10-31T12:22:04Z", "url": "https://research.draconitic.com/paper/299vmy52j0arm", "venue": "The Lancet regional health. Africa", "versions": [] }