Paediatric HIV Care Cascade: Retention in Care and Viral Suppression at a Tertiary Facility in Rivers State, South South Nigeria

Sustained retention in care and viral suppression are critical targets along the HIV treatment cascade for children living with HIV. Despite improvements in antiretroviral therapy (ART) access, gaps remain in achieving durable viral suppression among paediatric populations in Nigeria. This retrospective cohort study examines retention in care and viral suppression rates among HIV-positive children aged 0 to 14 years enrolled in the paediatric ART programme at a tertiary health facility in Rivers State, South South Nigeria, over a three-year period from 2021 to 2023. Records of 342 children enrolled in care were reviewed, tracking appointment adherence, ART regimen changes, viral load monitoring, and suppression outcomes. Retention in care at 12 months was 81.3%, declining to 68.7% at 24 months. Viral suppression (viral load below 1,000 copies per mL) was achieved in 67.4% of children with available viral load results. Children on second-line regimens demonstrated lower suppression rates (51.2%) compared to first-line (72.8%). Adolescents aged 10 to 14 years had the highest loss-to-follow-up rate (22.4%). Barriers to retention included disclosure challenges, stigma, caregiver fatigue, and transport costs. The study recommends differentiated service delivery models for adolescents, family-centred care approaches, and expanded point-of-care viral load testing. Keywords: paediatric HIV, ART, viral suppression, retention in care, Rivers State.