We categorized viral load as suppressed (viral load <1000 copies/ml) or unsuppressed (viral load ≥1000 copies/ml). Age was categorized into three groups: <10 years, 10–15 years and ≥15 years. We grouped primary caregivers as both parents, single parent and other non-parent relatives. Information collected included age, gender, weight, clinical and laboratory data (viral load and CD4 count), ART regimen, ART initiation and co-trimoxazole prophylaxis dates, primary caregiver and site of HIV care (hospital versus outreach). We abstracted data from patient treatment register to a structured data retrieval form. We summarized baseline characteristics using frequencies and proportions for categorical variables and medians for continuous variables stratified by baseline virologic outcomes. Chi-square tests, Fisher exact tests and Wilcoxon rank-sum tests were used to assess associations between baseline characteristics and virologic outcomes where appropriate. We compared viral load suppression profile in this cohort between baseline and follow-up using the chi-square test for marginal homogeneity between the paired viral load assessments. Suppression rates for children and adolescents who were switched and those that remained on non-nucleoside reverse transcriptase inhibitor-based first-line therapy after failing were estimated and compared. To understand the role of switching to protease inhibitor-based second-line ART on viral load suppression at follow-up, we fitted a logistic regression model of follow-up viral load status as a function of baseline viral load and an indicator of switching to second-line or not with an interaction term between the two predictors adjusting for age, gender, HIV care center and primary caregiver. Variables associated with viral load suppression at p < 0.20 in the univariable analysis and clinically relevant variables were added to the multivariable model. All statistical analyses were performed using Stata 15.1 (College Station, Tx).

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