Abstract:

Background: Unsuppressed viral load which is a strong indicator of treatment failure can lead to human immunodeficiency virus (HIV) related morbidity and mortality. Children below five years of age have increased risk of unsuppressed viral load due to various clinical and sociodemographic factors. The aim of this study was to determine the prevalence and factors associated with unsuppressed viral load among children below five years of age living with HIV in Mwanza, North West, Tanzania.

Methods: A cross-section study involving 279 children below five years of age who were on antiretroviral therapy (ART) for at least six months was conducted in four major care and treatment clinics (CTC) in Mwanza region from December 2020 to April 2021. Children were categorized as having unsuppressed HIV viral load if viral load count was more than 1000 ribonucleic acid (RNA) copies/mL six months after ART initiation. Data were collected by using structured questionnaire and analysis was done using STATA version 15.

Results: Of 279 children below five years of age, median age was 43.6 months and more than a half 144 (52%) were female. The majority of caregivers 194 (69.5%) were biological mothers and their mean age was 37.1 ± 12.4 years. Of 279 20 (7.2% 95%, CI: 4.2 – 10.2) had HIV virally unsuppressed (HIV RNA ≥1000 copies/mL). The duration on antiretroviral ‘s (ARV) less than 24 months (AOR 3.8, 95% CI: 1.2-12.0, P=0.026), poor ARVs antiretroviral’s (ARV) less than 24 months (AOR 3.8, 95% CI: 1.2-12.0, P=0.026), poor ARVs adherence in the past six months (AOR 5.7, 95% CI: 1.6-18.6, P=0.004), severe or moderate malnutrition (AOR 3.3, 95% CI: 1.2-8.9, P=0.020), were the children’s significant factors associated with unsuppressed HIV viral load among children below five years of age. Caregivers with no home supporters (AOR 4.4, 95% CI: 1.5-13.3, P=0.008), caregiver who attended at CTC by feet (AOR 4.0, 95% CI: 1.1 – 15.2, P=0.037), were the caregiver’s significant factor associated with unsuppressed HIV viral load.

Conclusion: As per international standards (UNAIDS’s 90-90-90 global targets), the prevalence of unsuppressed viral load among children below five years of age in Mwanza was low and it’s a good beginning to attain 95-95-95 by 2025. Short time on ARVs, moderate and severe malnutrition, poor ARV adherence, having no home supporter and attend CTC on feet were found to predict unsuppressed viral load. These factors should be used to identify children at risk of unsuppressed viral load and provide tailored support.