Submission ID 118245
| Issue/Objective | Multi-month dispensing (MMD) of antiretroviral therapy (ART), which provides a 3+ month supply of medication, reduces the logistical burden on families of children living with HIV (CLHIV). However, most published research focuses on adults, and barriers to pediatric MMD implementation include concerns about decreased healthcare interactions negatively affecting virologic outcomes. We hypothesized that pediatric MMD, viral load coverage (VLC), and suppression (VLS) would increase at USAID/PEPFAR-supported facilities during the study period. |
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| Methodology/Approach | We analyzed routinely collected pediatric (<15 years) PEPFAR data (FY2022- 2024), which are reported at the facility level. Key facility-level measures included: 3+MMD (proportion of CLHIV on ART receiving an ART supply of ≥3-months); proxy VLC (number of CLHIV on ART with a viral load result documented in a given quarter/number of CLHIV on ART two quarters prior); and VLS (number of CLHIV with a suppressed viral load <1000c/mL/number of CLHIV with a viral load result). |
| Results | There were 8383 facilities from 22 countries included in the analysis. Increases in overall mean 3+MMD (54.9% in FY2022 to 70.2% in FY2024), proxy VLC (74.0% to 85.6%), and VLS (83.7% to 88.9%) were observed from FY2022 to FY2024. Similarly, median 3+MMD increased from 61.1% (interquartile range (IQR) 20.0-87.8) in FY2022 to 80% (IQR 50-100) in FY2024, proxy VLC increased from 75% (IQR 50.0-97.1) to 87.5% (IQR 68.8-100), and VLS increased from median 88.9% (IQR 75-100) to 95.5% (IQR 83.3-100) |
| Discussion/Conclusion | 3+MMD, proxy VLC, and VLS increased from FY2022-FY2024 in USAID/PEPFAR-supported facilities. Although the aggregated nature of the data and potential confounders, such as pediatric dolutegravir rollout and potential cross-site client mobility, limit causal inference and preclude client-level conclusions, we did not find evidence that scaling up 3+MMD negatively impacts proxy VLC or VLS. Further studies are needed to confirm these findings and address remaining questions about optimal pediatric MMD implementation. |
| Presenters and affiliations | Robert Mugisha Radiant insurance Ltd Caleb Karangira Centre for Impact, Innovation and Capacity building for Health Information Systems and Nutrition (CIIC-HIN), Kigali, Rwanda uwase Nkusi Diana society for Family Health (SFH), Kigali, Rwanda |
