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在联合国艾滋病规划署“检测即治疗”项目启动时，内罗毕感染艾滋病毒的儿童和青少年人群中治疗依从性降低的证据。

Evidence of reduced treatment adherence among HIV infected paediatric and adolescent populations in Nairobi at the onset of the UNAIDS Universal Test and Treat Program.

作者信息

Kabogo Joseph, Muniu Erastus, Wamunyokoli Fred, Musoke Rachel, Songok Elijah

机构信息

Jomo Kenyatta University of Agriculture and Technology (JKUAT), Juja, Kenya.

Kenya Medical Research Institute (KEMRI), Mbagathi Road, Nairobi, Kenya.

出版信息

BMC Res Notes. 2018 Feb 17;11(1):134. doi: 10.1186/s13104-018-3205-0.

DOI:10.1186/s13104-018-3205-0
PMID:29452597
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5816400/
Abstract

OBJECTIVE: We conducted a retrospective cohort study to evaluate the efficacy of the World Health Organization (WHO) "Universal Test and Treat" (UTT) policy, initiated in Kenya in September 2016. Under this policy, every human immunodeficiency virus (HIV)-infected person should be initiated on antiretroviral therapy (ART). We compared intra- and inter-group viral suppression and ART adherence rates for pre-UTT (initiated on ART in March-August 2016) and UTT groups (initiated in September 2016). The study was conducted in a community outreach Program in Nairobi with 3500 HIV-infected children enrolled. RESULTS: 122 children and adolescents were initiated on first-line ART pre-UTT, and 197 during the UTT period. The 6 month viral suppression rate was 79.7% pre-UTT versus 76.6% UTT (P < 0.05). Suboptimal adherence was higher in the UTT than pre-UTT period (88 of 197, 44.7% and 44 of 122, 34%; P < 0.001). The decrease in adherence was greater among orphans (91.7% pre-UTT and 87.2% UTT, P = 0.001) and children 11-18 years. Our results show that successful implementation of the UTT policy in Africa is challenged by an increased risk of suboptimal adherence. There is a need to develop extra strategies to support adherence, especially among orphans and teenagers.

摘要

目的：我们开展了一项回顾性队列研究，以评估2016年9月在肯尼亚启动的世界卫生组织（WHO）“普遍检测与治疗”（UTT）政策的效果。根据该政策，每名感染人类免疫缺陷病毒（HIV）的患者均应开始接受抗逆转录病毒治疗（ART）。我们比较了UTT实施前（2016年3月至8月开始接受ART治疗）和UTT实施组（2016年9月开始）的组内和组间病毒抑制率及ART依从率。该研究在内罗毕的一个社区外展项目中进行，共有3500名感染HIV的儿童参与。 结果：122名儿童和青少年在UTT实施前开始接受一线ART治疗，197名在UTT实施期间开始治疗。UTT实施前6个月的病毒抑制率为79.7%，UTT实施期间为76.6%（P<0.05）。UTT实施期间的依从性欠佳情况高于UTT实施前（197名中的88名，44.7%；122名中的44名，34%；P<0.001）。孤儿（UTT实施前为91.7%，UTT实施期间为87.2%，P=0.001）和11 - 18岁儿童的依从性下降幅度更大。我们的结果表明，在非洲成功实施UTT政策面临依从性欠佳风险增加的挑战。需要制定额外策略来支持依从性，尤其是在孤儿和青少年中。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec25/5816400/820628686461/13104_2018_3205_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec25/5816400/820628686461/13104_2018_3205_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ec25/5816400/820628686461/13104_2018_3205_Fig1_HTML.jpg

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引用本文的文献

[1]
Characterizing the HIV care continuum among children and adolescents with HIV in eastern and southern Africa in the era of "Universal Test and Treat": A systematic review and meta-analysis.

J Int AIDS Soc. 2025-6

[2]
HIV interventions across the care continuum for adolescents in high-burden countries: a systematic review and meta-analysis.

EClinicalMedicine. 2024-11-28

[3]
Attrition one year after starting antiretroviral therapy before and after the programmatic implementation of HIV "Treat All" in Sub-Saharan Africa: a systematic review and meta-analysis.

BMC Infect Dis. 2023-8-28

[4]
Barriers and facilitators to anti-retroviral therapy adherence among adolescents aged 10 to 19 years living with HIV in sub-Saharan Africa: A mixed-methods systematic review and meta-analysis.

PLoS One. 2023

[5]
Evidence-based modeling of combination control on Kenyan youth HIV/AIDS dynamics.

PLoS One. 2020

[6]
Patient-mix, programmatic characteristics, retention and predictors of attrition among patients starting antiretroviral therapy (ART) before and after the implementation of HIV "Treat All" in Zimbabwe.

PLoS One. 2020-10-19

[7]
Brief Report: Time to Repeat Viral Load Testing Among Unsuppressed Adolescents and Young Adults Living With HIV in Kenya.

J Acquir Immune Defic Syndr. 2020-12-15

[8]
A Phenomenological Account of HIV Disclosure Experiences of Children and Adolescents from Northern and Southern Ghana.

Int J Environ Res Public Health. 2019-2-18

本文引用的文献

[1]
Can the UNAIDS 90-90-90 target be achieved? A systematic analysis of national HIV treatment cascades.

BMJ Glob Health. 2016-9-15

[2]
Rates and Predictors of Non-Adherence to Antiretroviral Therapy among HIV-Positive Individuals in Kenya: Results from the Second Kenya AIDS Indicator Survey, 2012.

PLoS One. 2016-12-1

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Challenges in initiating antiretroviral therapy for all HIV-infected people regardless of CD4 cell count.

Infect Dis Poverty. 2016-9-5

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Perspectives and Practice of HIV Disclosure to Children and Adolescents by Health-Care Providers and Caregivers in sub-Saharan Africa: A Systematic Review.

Front Public Health. 2016-8-12

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Equity in adherence to antiretroviral therapy among economically vulnerable adolescents living with HIV in Uganda.

AIDS Care. 2016-3

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HIV Orphanhood Research and the Representation of Older Orphans in Sub-Saharan Africa: A Literature Review.

J Assoc Nurses AIDS Care. 2016

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N Engl J Med. 2015-8-27

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Initiation of antiretroviral therapy at high CD4+ cell counts is associated with positive treatment outcomes.

AIDS. 2015-9-10

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The burden of disease on HIV-infected orphaned and non-orphaned children accessing primary health facilities in a rural district with poor resources in South Africa: a cross-sectional survey of primary caregivers of HIV-infected children aged 5-18 years.

Infect Dis Poverty. 2015-5-4

[10]
What makes orphans in Kigali, Rwanda, non-adherent to antiretroviral therapy? Perspectives of their caregivers.

J Int AIDS Soc. 2014-12-3

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