Predictors of Unsuppressed Viral Load Among Children Below Five Years of Age Living with Human Immunodeficiency Virus Infection in Mwanza, Tanzania

Abstract

Background: Children below five years of age have increased risk of unsuppressed viral load due to various sociodemographic
and clinical factors. This study investigated the prevalence and predictors of unsuppressed viral load
among HIV infected children below five years of age in Mwanza, Tanzania.
Methods: A cross sectional study involving 279 children below five years of age who were on antiretroviral therapy
(ART) for at least six months was conducted in the care and treatment clinics (CTC), from December 2020 to April 2021.
Results: A total, 20 (7.2%, 95% CI; 4.2-10.2) had unsuppressed HIV viral load. The duration on ARVs less than 24
months (AOR 3.8, 95% CI: 1.2-12.0; P=.026), poor ARVs adherence in the past six months (AOR 5.7; 95% CI: 1.6-
18.6; P=.004), severe or moderate malnutrition (AOR 3.3, 95% CI: 1.2-8.9; P=.020) and caregivers with no home
supporters (AOR 4.4, 95% CI: 1.5-13.3; P=.008) independently predicted unsuppressed HIV viral load among children
below five years of age.
Conclusions: More than 90% of children below the age of five years on ART had suppressed viral load. Short time on
ARVs, moderate and severe malnutrition, poor ARV adherence and economic constrain among caregivers 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.