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Abstract：
Viral suppression (VS) in children has remained suboptimal compared to that in adults. We evaluated the impact of transitioning children weighing < 20 kg to a pediatric formulation of dolutegravir (pDTG) on VS in Malawi. We analyzed routine retrospective program data from electronic medical record systems pooled across 169 healthcare facilities in Malawi supported by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF). We included children who weighed < 20 kg and received antiretroviral therapy (ART) between July 2021-June 2022. Using descriptive statistics, we summarized demographic and clinical characteristics, ART regimens, ART adherence, and VS. We used logistic regression to identify factors associated with post-transition VS. A total of 2468 Children Living with HIV (CLHIV) were included, 55.3% of whom were < 60 months old. Most (83.8%) had initiated on non-DTG-based ART; 71.0% of these had a viral load (VL) test result before transitioning to pDTG, and 62.5% had VS. Nearly all (99.9%) CLHIV transitioned to pDTG-based regimens. Six months after the transition, 52.7% had good ART adherence, and 38.6% had routine VL testing results; 81.7% achieved VS. Post-transition VS was associated with good adherence and pre-transition VS: adjusted odds ratios of 2.79 (95% CI 1.65-4.71), p < 0.001 and 5.32 (95% CI 3.23-9.48), p < 0.001, respectively. After transitioning to pDTG, VS was achieved in most children tested within the first 6 months. However, adherence remained suboptimal post-transition and VL testing at 6 months was limited. Interventions to improve VL testing and enhance ART adherence are still needed in CLHIV on pDTG-based regimens.
摘要：
与成人相比，儿童的病毒抑制（VS）仍然欠佳。我们评估了在马拉维将体重<20公斤的儿童过渡到dolutegravir（pDTG）儿科配方对VS的影响。我们分析了由伊丽莎白·格拉泽儿科艾滋病基金会（EGPAF）支持的马拉维169个医疗机构汇集的电子病历系统的常规回顾性计划数据。我们纳入了体重<20公斤并在2021年7月至2022年6月期间接受抗逆转录病毒治疗（ART）的儿童。使用描述性统计数据，我们总结了人口统计学和临床特征，ART方案，ART坚持，和VS。我们使用逻辑回归来确定与过渡后VS相关的因素。共包括2468名感染艾滋病毒的儿童（CLHIV），55.3%的人年龄<60个月。大多数（83.8％）已经开始使用非DTG-basedART;其中71.0％在过渡到pDTG之前有病毒载量（VL）测试结果，62.5%有VS。几乎所有（99.9％）CLHIV过渡到基于pDTG的方案。过渡六个月后，52.7%有良好的ART依从性，38.6%有常规VL检测结果；81.7%达到VS。过渡后VS与良好的依从性和过渡前VS相关：调整后优势比为2.79（95％CI1.65-4.71），p<0.001和5.32（95%CI3.23-9.48），p分别<0.001。过渡到pDTG后，在最初的6个月内，大多数接受测试的儿童都实现了VS。然而,过渡期后依从性仍不理想,6个月时的VL检测有限.在基于pDTG的方案的CLHIV中，仍需要干预以改善VL测试和增强ART依从性。
