在卢旺达，对接受抗逆转录病毒治疗 6、12 和 18 个月的 HIV 感染成年患者进行了全国代表性样本调查，发现其治疗依从性和病毒抑制率均较高。
High levels of adherence and viral suppression in a nationally representative sample of HIV-infected adults on antiretroviral therapy for 6, 12 and 18 months in Rwanda.
机构信息
ICAP at Columbia University, Mailman School of Public Health, New York, New York, United States of America.
出版信息
PLoS One. 2013;8(1):e53586. doi: 10.1371/journal.pone.0053586. Epub 2013 Jan 9.
BACKGROUND
Generalizable data are needed on the magnitude and determinants of adherence and virological suppression among patients on antiretroviral therapy (ART) in Africa.
METHODS
We conducted a cross-sectional survey with chart abstraction, patient interviews and site assessments in a nationally representative sample of adults on ART for 6, 12 and 18 months at 20 sites in Rwanda. Adherence was assessed using 3- and 30-day patient recall. A systematically selected sub-sample had viral load (VL) measurements. Multivariable logistic regression examined predictors of non-perfect (<100%) 30-day adherence and detectable VL (>40 copies/ml).
RESULTS
Overall, 1,417 adults were interviewed and 837 had VL measures. Ninety-four percent and 78% reported perfect adherence for the last 3 and 30 days, respectively. Eighty-three percent had undetectable VL. In adjusted models, characteristics independently associated with higher odds of non-perfect 30-day adherence were: being on ART for 18 months (vs. 6 months); younger age; reporting severe (vs. no or few) side effects in the prior 30 days; having no documentation of CD4 cell count at ART initiation (vs. having a CD4 cell count of <200 cells/µL); alcohol use; and attending sites which initiated ART services in 2003-2004 and 2005 (vs. 2006-2007); sites with ≥600 (vs. <600 patients) on ART; or sites with peer educators. Participation in an association for people living with HIV/AIDS; and receiving care at sites which regularly conduct home-visits were independently associated with lower odds of non-adherence. Higher odds of having a detectable VL were observed among patients at sites with peer educators. Being female; participating in an association for PLWHA; and using a reminder tool were independently associated with lower odds of having detectable VL.
CONCLUSIONS
High levels of adherence and viral suppression were observed in the Rwandan national ART program, and associated with potentially modifiable factors.
背景
需要有关于非洲接受抗逆转录病毒疗法（ART）的患者的依从性和病毒学抑制程度的普遍数据。
方法
我们在卢旺达 20 个地点的全国代表性成人 ART 治疗 6、12 和 18 个月的队列中进行了横断面调查，包括图表摘录、患者访谈和现场评估。使用 3 天和 30 天患者回忆来评估依从性。系统选择的亚样本进行了病毒载量（VL）测量。多变量逻辑回归分析了非完美（<100%）30 天依从性和可检测 VL（>40 拷贝/ml）的预测因素。
结果
共有 1417 名成年人接受了访谈，其中 837 人进行了 VL 测量。分别有 94%和 78%的人在过去 3 天和 30 天内报告了完美的依从性。83%的人 VL 不可检测。在调整后的模型中，与更高的非完美 30 天依从性相关的特征独立因素有：接受 ART 治疗 18 个月（而不是 6 个月）；年龄较小；在过去 30 天内报告严重（而不是没有或很少）副作用；在开始接受 ART 时没有 CD4 细胞计数记录（而不是 CD4 细胞计数<200 个/µL）；饮酒；在 2003-2004 年和 2005 年（而不是 2006-2007 年）开始提供 ART 服务的地点就诊；在有≥600 名（而不是<600 名）接受 ART 治疗的患者的地点就诊；或在有同伴教育者的地点就诊。参加艾滋病毒感染者/艾滋病患者协会；以及在经常进行家访的地点接受治疗，与较低的不依从率独立相关。在有同伴教育者的地点就诊的患者中，VL 可检测的几率更高。女性；参加艾滋病毒感染者/艾滋病患者协会；以及使用提醒工具与 VL 可检测的几率较低相关。
结论
在卢旺达国家 ART 项目中，观察到了高水平的依从性和病毒抑制，并且与潜在的可改变因素相关。
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