TOPLINE

Children living with HIV whose mothers received antiretroviral therapy (ART) or achieved viral load suppression were substantially more likely to receive ART themselves, and children who received ART were, in turn, more likely to achieve viral load suppression. Maternal engagement in care was therefore associated with child viral load suppression mainly through its association with child ART uptake.

METHODOLOGY

• This cross-sectional analysis of population-based surveys conducted across 13 countries in sub-Saharan Africa (2015-2019) estimated the prevalence of ART uptake and viral load suppression among children living with HIV and examined whether their mothers' own treatment status was associated with those outcomes.
• Researchers included 688 HIV-positive mother-child dyads of children younger than 15 years (mean age of children, 8.3 years; 51.3% girls) with linkable maternal data; 686 mother-child dyads were analyzed.
• Maternal engagement was defined by ART status (on ART, not on ART, alive with unknown status, or deceased) and viral load suppression status (suppressed, ie, < 1000 HIV RNA copies/mL, unsuppressed, alive with unknown status, or deceased).
• Outcomes were the child's own ART uptake (determined by antiretroviral drug detection or caregiver report) and viral load suppression (viral load < 1000 HIV RNA copies/mL).

TAKEAWAY

• ART uptake and viral suppression were lowest among the youngest children — 48.6% of those aged 0-4 years were on treatment and 27.5% were virally suppressed, compared with children aged 10-14 years — and among children born to the youngest mothers aged 15-24 (54.3% on ART; 22.9% virally suppressed).
• Outcomes for children living with HIV varied widely by country: ART uptake ranged from 46.0% in Zambia to 83.5% in Namibia; viral load suppression ranged from 30.4% in Tanzania to 75.4% in Namibia.
• Mothers' own ART use (odds ratio [OR], 3.99; 95% CI, 1.63-9.78) and viral load suppression (OR, 3.07; 95% CI, 1.63-5.78) were each significantly associated with higher odds of child viral load suppression, but both associations were attenuated and lost significance after adjusting for child ART uptake.
• Children were far more likely to be on ART themselves if their mothers were also on ART (OR, 20.42; 95% CI, 8.77-47.54) or virally suppressed (OR, 5.29; 95% CI, 2.95-9.48).

IN PRACTICE

"Our finding that maternal ART use and VLS [viral load suppression] status are associated with child VLS, indirectly through its role in child ART uptake, provides important insight into the critical role of maternal engagement in care in child outcomes," wrote the authors of the study.

SOURCE

The study was led by Jiawei He, PhD, Institute for Health Metrics and Evaluation, University of Washington, Seattle. It was published online on August 26, 2026, in JAMA Network Open.

LIMITATIONS

Because the study had a cross-sectional design, the researchers could not establish the order of events or conclude that maternal care caused the child outcomes. Some measurements were obtained from caregiver reports or using incomplete lab data, so the ART status for mothers and children could have been misclassified. In addition, the mother-child links were inferred from household records, which did not prove that the named woman was the child's main caregiver for HIV care.

DISCLOSURES

The study was supported by the National Institute of Allergy and Infectious Diseases. One author reported receiving salary support from the University of Washington through the National Institutes of Health. Several authors also disclosed receiving grants from various organizations, including the study funder.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.