{
  "abstract": "Background: We characterize antiretroviral therapy (ART) adherence among children and adolescents living with perinatal HIV (CALWH) and investigate its impact on treatment failure (TF) and drug resistance (DR). Methods: We enrolled Kenyan CALWH ≤15 years on NNRTI-based ART and monitored adherence over six months, with monthly, validated questionnaires and continuous MEMs (Medication Event Monitoring Systems) electronic dose monitoring. We assessed associations between TF (viral load (VL) >1,000 copies/mL; local guidelines) at 1 month (Blood Draw 1, BD1) and, for a subset, at 4 months (Blood Draw 2, BD2) and adherence using weighted logistic regression. Sanger genotyping identified reverse transcriptase DR mutations upon TF. Associations between number of mutations and adherence was modelled by weighted Poisson regression. Results: Among 692 CALWH (51% female; mean 8.4 years) on ART for mean 2.6 years between 2010−2013, 44% reported non-adherence at baseline. At BD1, 21% (N = 143/464) had TF. Reported non-adherence at enrollment and lower MEMS adherence between enrollment and BD1 were significantly associated with TF at BD1 (respectively, OR=1.25 per 1 unit higher non-adherence, 95% CI = 1.05 to 1.48, and OR=0.69 per 1 unit z-score higher MEMS adherence, 95% CI = 0.50 to 0.95). Among those with TF at BD1, 43% (31/72) had TF at BD2, higher MEMS adherence no longer predicted VL suppression. DR genotyping among those with TF at BD1 found fewer mutations for those without treatment interruption >48 hours (RR = 0.17, CI = 0.05 to 0.61), but among them, more mutations for those with longer interruptions (hours, log-10 RR = 2.48, CI = 1.10 to 5.59). More resistance was also associated with longer ART years (Log-10 RR = 1.47, CI = 1.15 to 1.89), and higher log-10 VL at BD1 (RR = 1.21, CI = 1.06 to 1.37)). MEMS adherence had significant, U-shaped relationship, with most mutations at lower (<50%) adherence. Conclusion: Well characterized non-adherence among Kenyan CALWH was common and resulted in increased risks for TF and extensive DR, highlighting treatment challenges.",
  "abstract_shown": true,
  "affiliations": [
    "Icahn School of Medicine at Mount Sinai, New York, New York, United States of America",
    "Arnhold Institute for Global Health, New York, New York, United States of America",
    "Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya",
    "Moi University, Eldoret, Kenya",
    "Brown University School of Public Health, Providence, Rhode Island, United States of America",
    "Global Health Program, College of Liberal Arts and Sciences, DePauw University, Greencastle, Indiana, United States of America",
    "Brown University Alpert Medical School, Providence, Rhode Island, United States of America"
  ],
  "article_type": "Research Article",
  "arxiv": null,
  "author_total": 15,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Rachel Vreeman"
    },
    {
      "affs": [
        1
      ],
      "name": "Winstone Nyandiko"
    },
    {
      "affs": [
        2
      ],
      "name": "Allison DeLong"
    },
    {
      "affs": [
        3
      ],
      "name": "Ashley Chory"
    },
    {
      "affs": [
        4
      ],
      "name": "Michael Scanlon"
    },
    {
      "affs": [
        5
      ],
      "name": "Josephine Aluoch"
    },
    {
      "affs": [
        6
      ],
      "name": "Edwin Sang"
    },
    {
      "name": "Vladimir Novitsky"
    },
    {
      "name": "Festus Sang"
    },
    {
      "name": "Celestine Ashimosi"
    },
    {
      "name": "Samuel Ayaya"
    },
    {
      "name": "Eslyne Jepkemboi"
    },
    {
      "name": "Millicent Orido"
    },
    {
      "name": "Joseph Hogan"
    },
    {
      "name": "Rami Kantor"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5vqgvm8f30gqm.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0355492",
  "fulltext_url": null,
  "id": "5vqgvm8f30gqm",
  "issns": [
    "1932-6203"
  ],
  "landing_url": "https://doi.org/10.1371/journal.pone.0355492",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2725|HIV/AIDS Research and Interventions"
    ],
    [
      "plos",
      "/Biology and life sciences/Immunology/Vaccination and immunization/Antiviral therapy/Antiretroviral therapy"
    ],
    [
      "plos",
      "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Immunodeficiency viruses/HIV"
    ],
    [
      "plos",
      "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Retroviruses/Lentivirus/HIV"
    ],
    [
      "plos",
      "/Biology and life sciences/Microbiology/Virology/Viral transmission and infection/Viral load"
    ],
    [
      "plos",
      "/Biology and life sciences/Organisms/Viruses/Immunodeficiency viruses/HIV"
    ],
    [
      "plos",
      "/Biology and life sciences/Organisms/Viruses/RNA viruses/Retroviruses/Lentivirus/HIV"
    ],
    [
      "plos",
      "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Immunodeficiency viruses/HIV"
    ],
    [
      "plos",
      "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Retroviruses/Lentivirus/HIV"
    ],
    [
      "plos",
      "/Medicine and health sciences/Immunology/Vaccination and immunization/Antiviral therapy/Antiretroviral therapy"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Immunodeficiency viruses/HIV"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Retroviruses/Lentivirus/HIV"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pediatrics"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pharmaceutics/Drug therapy"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pharmaceutics/Therapeutic drug monitoring"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pharmacology/Drug adherence"
    ],
    [
      "plos",
      "/Medicine and health sciences/Public and occupational health/Preventive medicine/Vaccination and immunization/Antiviral therapy/Antiretroviral therapy"
    ],
    [
      "plos",
      "/Research and analysis methods/Research design/Survey research/Questionnaires"
    ]
  ],
  "openalex": "W7213296767",
  "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0355492&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-15",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/5vqgvm8f30gqm.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:49Z",
      "native_id": "10.1371/journal.pone.0355492",
      "source": "plos",
      "url": "https://doi.org/10.1371/journal.pone.0355492"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "plos:immunology",
      "subfield": "immunology"
    },
    {
      "field": "biology",
      "origin": "plos:microbiology",
      "subfield": "microbiology"
    }
  ],
  "title": "Adherence to antiretroviral therapy and drug resistance impact evolving viral suppression among a cohort of children and adolescents living with perinatal HIV infection in western Kenya",
  "title_text": "Adherence to antiretroviral therapy and drug resistance impact evolving viral suppression among a cohort of children and adolescents living with perinatal HIV infection in western Kenya",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:49Z",
  "url": "https://research.draconitic.com/paper/5vqgvm8f30gqm",
  "venue": "PLOS One",
  "versions": []
}