article · AIDS Care
Managing paediatric HIV requires a clear understanding of what drives treatment outcomes in children and adolescents. A retrospective review of 109 medical records evaluated clinical and psychosocial factors linked to the severity of viral load among individuals aged 0 to 19 years in the Ngaka Modiri Molema District of South Africa. All included patients had detectable viral loads. The analysis revealed that reported missed doses were inversely associated with high-level virological failure, showing an unexpected relationship between self-reported non-adherence and severe viral outcomes. In addition, the duration of antiretroviral therapy was not independently linked to the severity of virological failure. These results highlight that standard clinical documentation of adherence may capture broader psychosocial and clinical contexts influencing how treatment challenges are reported, rather than strictly reflecting whether medication is taken as prescribed.
Accurately interpreting why paediatric HIV treatments fail is vital for clinical decision-making. When routine medical records show counterintuitive links between reported missed doses and viral severity, healthcare providers must recognise that patient self-reporting is complex. Relying solely on standard adherence notes without understanding the psychosocial setting may misdirect clinical interventions and patient support programmes.
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This retrospective record review examined psychosocial and clinical correlates of virological severity among children and adolescents aged 0-19 years with detectable viral load in the Ngaka Modiri Molema District, South Africa. Of 124 records screened, 109 were eligible and had a classifiable viral-load outcome. The most robust finding was that reported missed doses were inversely associated with high-level virological failure, whereas ART duration was not independently associated with severity. These findings suggest that routine adherence documentation may reflect not only medication-taking behaviour but also the psychosocial and clinical context in which treatment difficulties are reported.
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DOI: 10.1080/09540121.2026.2714554
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