Published in PLOS One on 2026-09-15, 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: Rachel Vreeman, Winstone Nyandiko, Allison DeLong, Ashley Chory, Michael Scanlon, Josephine Aluoch, Edwin Sang, Vladimir Novitsky, Festus Sang, Celestine Ashimosi, Samuel Ayaya, Eslyne Jepkemboi, Millicent Orido, Joseph Hogan, Rami Kantor, YAGAI BOUBA
Source: PLOS One • DOI 10.1371/journal.pone.0355492
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
We characterize antiretroviral therapy (ART) adherence among children and adolescents living with perinatal HIV (CALWH) and investigate its impact on treatment failure (TF) and drug resistance (DR).
We enrolled Kenyan CALWH ≤15 years on NNRTI-based ART and monitored adherence over six months, with monthly, validated questionnaires and continuous MEMs (Medication Event Monitoring Systems) electronic dose monitoring. We assessed associations between TF (viral load (VL) >1,000 copies/mL; local guidelines) at 1 month (Blood Draw 1, BD1) and, for a subset, at 4 months (Blood Draw 2, BD2) and adherence using weighted logistic regression. Sanger genotyping identified reverse transcriptase DR mutations upon TF. Associations between number of mutations and adherence was modelled by weighted Poisson regression.
Among 692 CALWH (51% female; mean 8.4 years) on ART for mean 2.6 years between 2010−2013, 44% reported non-adherence at baseline. At BD1, 21% (N = 143/464) had TF. Reported non-adherence at enrollment and lower MEMS adherence between enrollment and BD1 were significantly associated with TF at BD1 (respectively, OR=1.25 per 1 unit higher non-adherence, 95% CI = 1.05 to 1.48, and OR=0.69 per 1 unit z-score higher MEMS adherence, 95% CI = 0.50 to 0.95). Among those with TF at BD1, 43% (31/72) had TF at BD2, higher MEMS adherence no longer predicted VL suppression. DR genotyping among those with TF at BD1 found fewer mutations for those without treatment interruption >48 hours (RR = 0.17, CI = 0.05 to 0.61), but among them, more mutations for those with longer interruptions (hours, log-10 RR = 2.48, CI = 1.10 to 5.59). More resistance was also associated with longer ART years (Log-10 RR = 1.47, CI = 1.15 to 1.89), and higher log-10 VL at BD1 (RR = 1.21, CI = 1.06 to 1.37)). MEMS adherence had significant, U-shaped relationship, with most mutations at lower (<50%) adherence.
Well characterized non-adherence among Kenyan CALWH was common and resulted in increased risks for TF and extensive DR, highlighting treatment challenges.
Introduction
The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that 1.7 million children are living with HIV worldwide [1]. Nearly 90% of these children live within African countries, with the highest incidence in South Africa, Mozambique, United Republic of Tanzania, and Kenya [2]. In Kenya, there are between 120,000 and 230,000 children (ages 0–19) living with HIV, with 61% estimated to be on antiretroviral therapy (ART) [2,3].
Most children perinatally infected with HIV in African countries lacked access to ART until after 2000, when [USAID-PEPFAR]-supported programs expanded ART availability for HIV prevention and treatment [4]. As these programs grew between 2003–2015, many children and adolescents living with HIV (CALWH) gained access to non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens, similar to the Kenyan cohort studies here. Despite major improvements in access and corresponding declines in pediatric HIV morbidity and mortality, many resource-limited settings (RLS) lacked capacity for detailed adherence measurement or viral load (VL) monitoring. Consequently, data linking childhood adherence to later treatment failure and drug resistance (DR) remain limited [5–7]. Treatment failure (TF), defined by viral non-suppression on ART, drives accumulation of drug resistance mutations (DRMs), reducing future treatment options and increasing morbidity and mortality [8,9]. These past challenges may also shape outcomes I n the current ART era, even on new regimens [10–16]. This study aims to characterize adherence behaviors in this first generation of CALWH “survivors”, and to fill key gaps in understanding their treatment failure and drug resistance histories as they transition into adulthood.
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 Rachel Vreeman, Winstone Nyandiko, Allison DeLong, Ashley Chory, Michael Scanlon, Josephine Aluoch, Edwin Sang, Vladimir Novitsky, Festus Sang, Celestine Ashimosi, Samuel Ayaya, Eslyne Jepkemboi, Millicent Orido, Joseph Hogan, Rami Kantor, YAGAI BOUBA. 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.
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