Evidence map›Paper›PMID 40307826›Full record

ArticleBMC infectious diseases2025

Feasibility of smartphone-enabled asynchronous video directly observed therapy to improve viral suppression outcomes among HIV unsuppressed children and adolescents in Kenya.

Paul Wekesa, Margaret Ndisha, Boniface Makone, Marc Bulterys, Evelyn Ngugi, Kevin Kamenwa, Abraham Katana, Kevin Owuor, Immaculate Mutisya

Abstract read
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Article in BMC infectious diseases, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Paul WekesaCenter for Health Solutions, Nairobi, Kenya. pwekesa@chskenya.org.
Margaret NdishaDivision of Global HIV&TB (DGHT), Global Health Center, U.S. Centers for Disease Control and Prevention (CDC), Nairobi & Kisumu, Kenya.
Boniface MakoneDivision of Global HIV&TB (DGHT), Global Health Center, U.S. Centers for Disease Control and Prevention (CDC), Nairobi & Kisumu, Kenya.
Marc BulterysDivision of Global HIV&TB (DGHT), Global Health Center, U.S. Centers for Disease Control and Prevention (CDC), Nairobi & Kisumu, Kenya.
Evelyn NgugiDivision of Global HIV&TB (DGHT), Global Health Center, U.S. Centers for Disease Control and Prevention (CDC), Nairobi & Kisumu, Kenya.
Kevin KamenwaCenter for Health Solutions, Nairobi, Kenya.
Abraham KatanaDivision of Global HIV&TB (DGHT), Global Health Center, U.S. Centers for Disease Control and Prevention (CDC), Nairobi & Kisumu, Kenya.
Kevin OwuorCenter for Health Solutions, Nairobi, Kenya.
Immaculate MutisyaDivision of Global HIV&TB (DGHT), Global Health Center, U.S. Centers for Disease Control and Prevention (CDC), Nairobi & Kisumu, Kenya.

Funding

U.S. Centers for Disease Control and Prevention CoAg number 1U2GGH000097
6 · The paper itself

Abstract

backgroundVideo directly observed therapy (VDOT) has been used as an acceptable, cost-effective, client-centered intervention for tuberculosis management. VDOT targeting children (0-14 years) and adolescents (15-19 years) living with HIV (CALHIV) not achieving viral suppression (VS) [i.e., < 1000 copies/ml] was piloted in 73 facilities in Kenya. We conducted a feasibility study on the utilization and re-suppression rates of clients enrolled in VDOT.

methodsA review of data from 223 virally unsuppressed clients aged between 0-19 years on antiretroviral therapy (ART) who were enrolled to use the VDOT application daily for at least 12 weeks between February 2021 and October 2022 at 73 health facilities was conducted. Clients stopped using the application upon achieving VS. VS was assessed after at least 12 weeks of VDOT follow-up through self-care or healthcare worker (HCW)-led approaches. Using a multivariable Cox Proportional Hazards regression model, we assessed demographic and clinical determinants of VS presenting adjusted hazard ratios (aHR).

resultsMost users, 163 (73.1%) were adolescents aged 10-19 years. Only 19 (8.5%) were on self-care VDOT. Median time on follow-up was 19 weeks, with 126 videos uploaded, and 75% VDOT adherence. Over three-fourths, 176 (78.9%) had achieved VS during follow-up. Results showed a higher likelihood of VS among children on once-daily compared to twice-daily ARV dosage, aHR = 2.51 (95% CI: 2.06 - 3.05), and those on second- or third-line regimens compared to those on first-line regimens, aHR = 3.05 (95% CI: 1.78 - 5.22). Similarly, those on a DTG-based regimen had a higher likelihood of VS compared to those on LPV/r-based, ATV/s-based, or EFV-based regimens, aHR = 1.95 (95% CI: 1.25 - 3.06). Children receiving care from guardians and siblings had a higher likelihood of VS compared to those receiving care from parent caregivers, 1.61 (95% CI: 1.27-2.03), and 2.00 (95% CI: 1.12 - 3.57), respectively.

conclusionVDOT supported the achievement of VS among unsuppressed CALHIV on antiretroviral treatment and was significantly associated with dosage frequency, antiretroviral regimen, first- or second-line therapy, antiretroviral regimen classification, and type of caregiver. Findings suggest the utility of VDOT among unsuppressed CALHIV in resource-limited settings.

Indexed as

Anti-HIV AgentsDirectly Observed TherapyHIV InfectionsSmartphoneAdolescentChildChild, PreschoolFeasibility StudiesFemaleHumansInfantInfant, NewbornKenyaMaleViral LoadYoung AdultAnti-HIV AgentsAntiretroviral treatmentChildren and adolescents living with HIVKenyaVideo directly observed therapy (VDOT)Viral suppression

Identifiers

PMID40307826
PMCPMC12042574

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.