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IMPACT OF POINT-OF-CARE HIV VIRAL LOAD TESTING IN KENYAN CHILDREN: A RANDOMIZED
TRIAL


ABSTRACT BODY

Kenya has a large burden of pediatric HIV and viral suppression (VS) remains
lower among children living with HIV (CLHIV) than adults; feasible, scalable,
and cost-effective approaches to ensure VS among CLHIV are urgently needed. The
goal of the Opt4Kids study was to determine the impact of point-of-care (POC)
viral load (VL) and targeted drug resistance mutation (DRM) testing in improving
VS among children on antiretroviral therapy (ART).

We conducted a randomized controlled trial to evaluate the use of POC VL and
targeted DRM testing among children aged 1-14 years on ART at five health
facilities in western Kenya. Children were randomized 1:1 to intervention (POC
VL every 3 months, targeted DRM testing for VL ?1000 copies/ml, and clinical
management support) vs. control (standard-of-care: VL testing every 6 months,
DRM restricted to second line ART failure via centralized approvals) groups and
followed for 12 months. Our primary outcome was VS (VL <1000 copies/mL) 12
months after enrollment by study group.

Of the 704 participants enrolled, the median age at enrollment was 9 years
(interquartile range [IQR] 7, 12), 344 (49%) were female, and the median time on
ART was 5.8 years (IQR 3.1, 8.6). At 12 months, 90% (283/313) in the
intervention group and 92% (287/313) in the control group were virally
suppressed (risk ratio (RR) 0.99, 95% confidence interval [CI] 0.94, 1.03). We
identified 122 episodes of viremia in intervention participants, of which 107
(88%) samples successfully underwent DRM testing. In contrast, 144 episodes of
viremia were identified but only two DRM tests were conducted in the control
group. After any non-VS, children were not more likely to achieve VS at
12-months in the intervention vs. control group (RR 1.08, 95% CI 0.92, 1.27).
The median turnaround time in days for VL results was 1 (IQR 0, 1) and 14 (IQR
9, 21) in the intervention and control groups, respectively.

Overall, VS was high in both groups and was not significantly improved among
CLHIV undergoing our intervention of POC VL and targeted DRM testing compared to
standard of care. However, VL turnaround time was faster in the intervention
group, which could be useful programmatically. Further research is needed to
evaluate combination interventions, that best utilize POC VL testing coupled
with psychosocial support, to optimize VS for CLHIV.

CONFERENCE DATES AND LOCATION

February 12-16, 2022 | Virtual

SESSION TITLE

MATERNAL AND CHILD HEALTH: NEW INSIGHTS INTO HEPATITIS, SARS-CoV-2, AND HIV

SESSION NUMBER

Oral-02

AUTHORS

Rena Patel1, Patrick Oyaro2, Katherine K. Thomas1, James Wagude3, Irene Mukui4,
Eunice Kinywa3, Frederick Oluoch3, Leonard Kingwara5, Evelyn Brown6, Enericah C.
Kariuki6, Nashon Y. Odhiambo6, Grace John-Stewart1, Lisa Abuogi7

PRESENTING AUTHOR AND INSTITUTION

Rena Patel
University of Washington

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