Factors associated with unsuppressed HIV viral load among children under 15 years in sub-Saharan africa: A systematic review

BACKGROUND: Viral suppression among children living with HIV remains suboptimal in sub-Saharan Africa. The marked heterogeneity in suppression rates across countries underscores the need for comparative analyses to elucidate context-specific determinants. This systematic review aims to synthesize existing evidence on factors associated with unsuppressed viral loads in paediatric populations. METHODS: A systematic review was conducted to examine viral load suppression among children under 15 years in sub-Saharan Africa. Comprehensive searches were performed across four major databases: PubMed, Google Scholar, Embase, and Web of Science. Eligible studies were published in English between 2010 and 2024, focused exclusively on paediatric populations in Africa, and available in full text. Relevant data were systematically extracted and compiled in a structured Excel database to prevent duplication and facilitate rigorous, methodologically sound analysis. RESULTS: Of the 161 articles initially identified, 16 met the predefined inclusion criteria for this review. These studies were conducted across multiple sub-Saharan African countries and used various methodological designs. The most frequently reported factors associated with an unsuppressed viral load among children receiving antiretroviral therapy (ART) were suboptimal treatment adherence, malnutrition, low maternal educational attainment, a high baseline viral load, and missed clinical appointments. Adherence to ART was the most extensively analysed variable, and poor adherence was consistently and strongly associated with virological failure. CONCLUSION: Viral suppression among children living with HIV in sub-Saharan Africa remains unacceptably low. This review emphasized key preventable factors mostly poor adherence. Targeted, urgent interventions are needed to improve outcomes for this vulnerable population

• Epidemiology and Determinants of Health
  • Determinants of Health
• Determinants of Health
  • Food security
  • Education
• Population(s)
  • Children or Youth (less than 18 years old)
  • General HIV+ population
• Prevention, Engagement and Care Cascade
  • Engagement and Care Cascade
• Engagement and Care Cascade
  • Retention in care
  • Treatment
• Co-infections
  • Tuberculosis
• Health Systems
  • Governance arrangements