Abstract: Viral load suppression among children living with Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) is critical to sustaining quality of life, preventing treatment failure, achieving optimal ART outcomes, and preventing the transmission of multi-drug-resistant virus later in life. Children aged 0 - 14 years are disproportionately more affected by poor viral load suppression than adolescents, suggesting that this age group requires specific attention. This study sought to determine the clinical factors affecting viral load suppression in pediatric HIV and AIDS care in Meru County Referral Hospital.