Clinical and psychosocial correlates of virological severity in paediatric HIV: a retrospective cross-sectional record review in South Africa.

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.