Insights from caregivers of children on ART

Pediatric HIV Viral Load Suppression: Qualitative Insights of Barriers and Facilitators among Caregivers of Children on ART in High Volume Sites in Kisumu County (Nicollate Okoko et al) findings: The number of virally suppressed HIV positive children remains unacceptably low at 73% in low and middle income countries. Focus group discussions among caregivers of children on ART were carried out to gain insights. Caregivers had a general understanding of viral load and weight-based dosing. To reach viral load suppression caregivers reported the need for medication and clinic appointment adherence, HIV-disclosure to children, and assisted-disclosure and ART management, whereas the barriers to viral suppression included concerns with disclosure such as anticipated stigma “I feel that it is difficult to discuss HIV with a child because maybe the child is not one that can keep a secret. Maybe you could help us by organizing group meetings which such issues can be discussed?” as well as disclosure beyond the immediate family, and determining the appropriate age for disclosure to children. Viral load testing schedules were also challenging and ambiguous, along with medication barriers including pill burden, timing, side effects, and health system challenges such as long wait times, appointment frequency, unfriendly child medication, and negative provider reactions when there are missed treatment doses.  Assisted-disclosure and support for caregivers and their children is critical, as well as facility-level interventions and differentiated care models for children and adolescents to enhance care and viral load suppression. Presented at the Inter-CFAR Research Symposium, Jan 31-Feb 2, 2019, in Machakos, Kenya.