Jackson, ChristiRehman, Andrea M.McHugh, GraceGonzalez‑Martinez, CarmenNgwira, Lucky G.Bandason, TsitsiMujuru, HildaOdland, Jon OyvindCorbett, Elizabeth L.Ferrand, Rashida A.Simms, Victoria2024-03-152024-03-152023-06-11Jackson, C., Rehman, A.M., McHugh, G. et al. Risk factors for sustained virological non-suppression among children and adolescents living with HIV in Zimbabwe and Malawi : a secondary data analysis', BMC Pediatrics, vol. 22, art. 340, pp. 1-9. https://DOI.org/10.1186/s12887-022-03400-41471-2431 (online)10.1186/s12887-022-03400-4http://hdl.handle.net/2263/95218AVAILABILITY OF DATA AND MATERIALS : The datasets used and/or analysed during the current study are not available publicly since the trial was performed at a time when data sharing was not the norm, and therefore participant consent for wider sharing of data was not obtained, but datasets are available from the corresponding author on reasonable request after following institutional requirements.BACKGROUND : 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 first-line ART and 152/347 (43.8%) had virological non-suppression. 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. CONCLUSIONS : 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. TRIAL RGISTRATION : Secondary cohort analysis of data from BREATHE trial (Clinicaltrials.gov NCT02 426112).en© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License.AdolescentChronic lung diseaseHIV viral loadResistanceViral non-suppressionAntiretroviral therapy (ART)Human immunodeficiency virus (HIV)ZimbabweMalawiSDG-03: Good health and well-beingArticle