Published in PLOS One on 2026-05-15, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Amon Exavery, Daisy Kisyombe, Alison Koler, John Charles, Nemes Mallya, Erica Kuhlik, Asheri Barankena, Rose Fovo, Godfrey Martin Mubyazi, Tom Ventimiglia, Jennifer Mulik, Gloria Sangiwa, Levina Kikoyo, Sarah Nanzigu, Tacilta Nhampossa
Source: PLOS One • DOI 10.1371/journal.pone.0349141
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Achieving and sustaining viral load suppression (VLS) among children living with HIV remains challenging despite the availability of antiretroviral therapy (ART), primarily due to adherence difficulties. This study evaluated the effects of three interventions under the ACHIEVE project on viral load outcomes (viral rebound and viral suppression) among HIV-positive orphaned and vulnerable children aged 0–17 years (hereafter referred to as CLHIV) receiving ART in Tanzania.
This is a longitudinal analysis of 26,257 CLHIV who are beneficiaries of the ACHIEVE project in Tanzania, each with at least two viral load (VL) test results between 2021 and 2023. VL outcomes were assessed using two analytic groups: Group 1 included 21,448 CLHIV with undetectable VL (<50 copies/mL) at baseline, where those maintaining undetectable VL were compared with those experiencing viral rebound (VL ≥ 50 copies/mL) at follow-up. Group 2 comprised 4,809 CLHIV with detectable VL (≥50 copies/mL) at baseline, where those achieving undetectable VL at follow-up were compared with those who did not. The study used a multivariable logistic regression model and propensity score matching (PSM) to evaluate the effects of ACHIEVE project interventions–WORTH Yetu economic strengthening, linkage to teen/paediatric clubs, and health insurance–on viral rebound (Group 1), and the achievement of an undetectable viral load (Group 2).
Overall, 13.1% (2,805/21,448) of Group 1 CLHIV experienced viral rebound at follow-up. CLHIV who received ACHIEVE interventions were 23.2% less likely to experience viral rebound compared to those who did not (aOR = 0.768, 95% CI 0.668–0.882, p < 0.001). In Group 2, 70.9% (3,411/4,809) achieved an undetectable viral load at follow-up, with those who received ACHIEVE interventions being 31.9% more likely to achieve an undetectable viral load compared to those who did not (aOR = 1.319, 95% CI 1.059–1.643, p = 0.014). These findings were confirmed in the PSM analysis (viral rebound: β = – 0.047, 95% CI –0.072 – –0.021, p < 0.001; achieving undetectable viral load: β = 0.10, 95% CI 0.04–0.16, p = 0.001).
The ACHIEVE project interventions were significantly associated with a reduced likelihood of viral rebound, and an increased likelihood of achieving undetectable viral load among CLHIV, highlighting their potential to enhance ART outcomes. These findings suggest that expanding similar community-based interventions could further contribute to HIV treatment efficacy and support more children in achieving and maintaining an undetectable viral load, particularly those at risk of viral rebound or persistent high viral load. Future research should explore strategies for scaling these interventions and evaluating their long-term impact.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Amon Exavery, Daisy Kisyombe, Alison Koler, John Charles, Nemes Mallya, Erica Kuhlik, Asheri Barankena, Rose Fovo, Godfrey Martin Mubyazi, Tom Ventimiglia, Jennifer Mulik, Gloria Sangiwa, Levina Kikoyo, Sarah Nanzigu, Tacilta Nhampossa. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Virologic suppression among HIV-positive pregnant and lactating women receiving antiretroviral therapy in Africa: A systematic review and meta-analysis
- Evidence brief: Factors associated with high viral load among HIV clients aged 15 years and older receiving treatment in Tanga city council, Tanzania: A facility-based cross-sectional study
- Evidence brief: The effect of antiretroviral therapy adherence on viral load suppression rate among people living with HIV in Ethiopia: A systematic review and meta-analysis
