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COVID-19 and HIV viral load suppression in children and adolescents in Durban, South Africa


Asandile Mathamo
Kimesh L. Naidoo
Jienchi Dorward
Thashir Archary
Christian Bottomley
Moherndran Archary

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic poses challenges to paediatric and adolescent HIV treatment programme. Modelling  exercises raised concerns over potential impact of disruptions.


Objectives: To describe the impact of the COVID-19 pandemic on viral load (VL) testing among infants, children and adolescents on antiretroviral  treatment (ART) in Durban, South Africa.


Method: Routinely collected, aggregated data of monthly VL counts done on all those less than 19 years old from January 2018 to January 2022 was  analysed. An interrupted time series analysis using a Prais-Winsten linear regression model, including terms for lockdowns and excess mortality determined VL trends.


Results: The unadjusted mean VL was 2166 (confidence interval [CI]: 252.2) and 2016 (CI: 241.9), P = 0.039, and percentage VL suppression rates (72.9%,  CI: 2.4% vs 73.6%, CI: 1.8%) across COVID and pre-COVID periods, showing no significant difference, P = 0.262. In the interrupted time series analysis,  modelled monthly VL counts did not differ significantly by lockdown level (e.g., level 5 lockdown: –210.5 VLs, 95% CI: –483.0 to +62.1, P = 0.138) or excess  mortality (–0.1, 95% CI: –6.3 to 6.1, P = 0.969). A significant downward trend in VL testing over time, including during the pre-COVID-19 period (–6.6 VL per  month, 95% CI: –10.4 to –2.7, P = 0.002), was identified.


Conclusion: Viral load suppression for children and adolescents were not negatively affected by COVID-19. A trend of decrease in VL testing predated  COVID-19.


What this study adds: Evidence presented that HIV VL testing and suppression rates in children and adolescents in a high burden setting were  sustained through the COVID pandemic.


Journal Identifiers


eISSN: 2078-6751
print ISSN: 1608-9693