Jackson, ChristiRehman, Andrea M.McHugh, GraceGonzalez‑Martinez, CarmenNgwira, Lucky G.Bandason, TsitsiMujuru, HildaOdland, Jon OyvindCorbett, Elizabeth L.Ferrand, Rashida A.Simms, Victoria2022-07-252022-07-252022-06Jackson, C., Rehman, A.M., McHugh, G., Gonzalez-Martinez, C., Ngwira, L.G., Bandason, T., Mujuru, H., Odland, J.O., Corbett, E.L., Ferrand, R.A. & Simms, V. Risk factors for sustained virological non-suppression among children and adolescents living with HIV in Zimbabwe and Malawi: a secondary data analysis. BMC Pediatrics 2022 Jun 11;22(1):340. doi: 10.1186/s12887-022-03400-4.1471-2431 (online)10.1186/s12887-022-03400-4https://repository.up.ac.za/handle/2263/86439BACKGROUND: We investigated risk factors for sustained virological non-suppression (viral load≥1000 copies/ml on two tests 48 weeks apart) among children and adolescents accessing HIV care in public sector clinics in Harare, Zimbabwe and Blantyre, Malawi. METHODS: Participants were enrolled between 2016 and 2019, were aged 6–19 years, living with HIV, had chronic lung disease (FEV z-score< -1) and had taken antiretroviral therapy (ART) for at least six months. We used multivariate logistic regression to identify risk factors for virological non-suppression after 48 weeks, among participants who were non-suppressed at enrolment. RESULTS: At enrolment 258 participants (64.6%) were on frst-line ART and 152/347 (43.8%) had virological non-sup‑ pression. After 48 weeks 114/313 (36.4%) were non-suppressed. Participants non-suppressed at baseline had almost ten times higher odds of non-suppression at follow-up (OR=9.9, 95%CI 5.3–18.4, p<0.001). Of those who were nonsuppressed at enrolment, 87/136 (64.0%) were still non-suppressed at 48 weeks. Among this group non-suppression at 48 weeks was associated with not switching ART regimen (adjusted OR=5.55; 95%CI 1.41–21.83); p=0.014) and with older age. Twelve participants switched regimen in Zimbabwe and none in Malawi. CONCLUSION: Viral non-suppression was high among this group and many with high viral load were not switched to a new regimen, resulting in continued non-suppression after 48 weeks. Further research could determine whether improved adherence counselling and training clinicians on regimen switches can improve viral suppression rates in this population.en© The Author(s) 2022. Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License.AdolescentAntiretroviral therapyChronic lung diseaseHIV viral loadResistanceViral non-suppressionHuman immunodeficiency virus (HIV)Article