Vreeman Rachel C, Ayaya Samuel O, Musick Beverly S, Yiannoutsos Constantin T, Cohen Craig R, Nash Denis, Wabwire Deo, Wools-Kaloustian Kara, Wiehe Sarah E
Indiana University School of Medicine, Indianapolis, IN, United States of America.
Regenstrief Institute, Inc, Indianapolis, IN, United States of America.
PLoS One. 2018 Feb 21;13(2):e0191848. doi: 10.1371/journal.pone.0191848. eCollection 2018.
To describe antiretroviral therapy (ART) adherence and associated factors for a large HIV-infected pediatric cohort followed by sites of the East Africa International Epidemiologic Databases to Evaluate AIDS (IeDEA) consortium.
This study utilized prospectively collected clinical data from HIV-infected children less than 13 years of age who initiated ART within 4 clinical care programs (with 26 clinical sites) in Kenya, Uganda, and Tanzania and were followed for up to 6 years. Programs used one of 3 adherence measures, including 7-day quantitative recall, 7-day categorical recall, and clinician pill assessments. We fit a hierarchical, three-level, logistic-regression model to examine adherence, with observations nested within patient, and patients within the 26 sites providing pediatric HIV data to this analysis.
In East Africa, 3,304 children, 52.0% male, were enrolled in care and were subsequently observed for a median of 92 weeks (inter-quartile range [IQR] 50.3-145.0 weeks). Median age at ART initiation was 5.5 years ([IQR] 3.0-8.5 years). "Good" adherence, as reported by each clinic's measures, was extremely high, remaining on average above 90% throughout all years of follow-up. Longer time on ART was associated with higher adherence (adjusted Odds Ratio-aOR-per log-transformed week on ART: 1.095, 95% Confidence Interval-CI-[1.052-1.150].) Patients enrolled in higher-volume programs exhibited higher rates of clinician-assessed adherence (aOR per log-500 patients: 1.174, 95% CI [1.108-1.245]). Significant site-level variability in reported adherence was observed (0.28), with even higher variability among patients (0.71). In a sub-analysis, being an orphan at the start of ART was strongly associated with lower ART adherence rates (aOR: 0.919, 95% CI [0.864-0.976]).
Self-reported adherence remained high over a median of 1.8 years in HIV care, but varied according to patient-level and site-level factors. Consistent adherence monitoring with validated measures and attention to vulnerable groups is recommended.
描述东非国际艾滋病流行病学数据库评估联盟（IeDEA）各站点所追踪的大型HIV感染儿童队列的抗逆转录病毒疗法（ART）依从性及相关因素。
本研究利用前瞻性收集的临床数据，这些数据来自肯尼亚、乌干达和坦桑尼亚4个临床护理项目（共26个临床站点）中13岁以下开始接受ART治疗的HIV感染儿童，随访时间长达6年。各项目采用3种依从性测量方法之一，包括7天定量回忆法、7天分类回忆法和临床医生药丸评估法。我们拟合了一个分层三级逻辑回归模型来检验依从性，观察值嵌套在患者内，而患者则来自为该分析提供儿科HIV数据的26个站点。
在东非，3304名儿童（52.0%为男性）登记接受护理，随后中位观察时间为92周（四分位间距[IQR]50.3 - 145.0周）。开始接受ART治疗的中位年龄为5.5岁（[IQR]3.0 - 8.5岁）。根据各诊所的测量方法报告的“良好”依从性极高，在整个随访期间平均保持在90%以上。接受ART治疗的时间越长，依从性越高（每ART治疗对数转换周的调整优势比 - aOR - ：1.095，95%置信区间 - CI - [1.052 - 1.150]）。登记在患者数量较多项目中的患者，临床医生评估的依从率较高（每500名患者对数的aOR：1.174，95%CI[1.108 - 1.245]）。观察到报告的依从性存在显著的站点水平差异（0.28），患者之间的差异甚至更大（0.71）。在一项亚分析中，ART治疗开始时成为孤儿与较低的ART依从率密切相关（aOR：0.919，95%CI[0.864 - 0.976]）。
在HIV护理中，自我报告的依从性在中位1.8年期间一直保持较高水平，但因患者水平和站点水平因素而异。建议采用经过验证的测量方法持续监测依从性，并关注弱势群体。
