3.3. Clinical Management and Outcomes of Children with DRT
VF
The CMC carried out case reviews for all participants with DRT results and recommended an ART regimen change for 46 (43%) out of the 106 participants with a DRT. In the control group, 22 participants had a DRT after the 12-month study visit, and 100% had any DR with 19 (86%) with major DR. Eight of those with results (36.4%) had a recommendation for an ART regimen change after clinical review. The control group participants were not followed beyond this final study visit.In the intervention group, 38/88 (43.2%) were recommended to change ART after a case review, while 34 (38.6%) were advised to continue the current regimen. An additional 12 (13.6%) intervention participants underwent an ART change due to a national transition to dolutegravir that was initiated by the clinic providers. Of those with an ART change recommendation in the intervention group, 35 (92.1%) had changed to the recommended ART by the study end. All the intervention participants with an ART change recommendation had clinically significant DR. Nearly a third (For the intervention participants with DRT prior to the final study visit (In this cohort of over 700 children on ART in Kenya, we detected high levels of DR in CHIV with VF. All children with VF had some DR, the majority of whom had major DR. Children on ART for >2 years and those with a history of VF were significantly more likely to have major DR. We observed that half of the CHIV with DR re-suppressed by the study end following the use of a multidisciplinary care team approach for case review and clinical management recommendations. Our study provides data on evolving DR patterns in CHIV and can inform prioritization approaches of DRT for vulnerable groups of CHIV as new ARV options become available.