IRD, INSERM, University of Montpellier, TransVIHMI, Montpellier, France.
CREMER, Yaoundé, Cameroon.
HIV Med. 2019 Jan;20(1):38-46. doi: 10.1111/hiv.12681. Epub 2018 Oct 25.
In terms of HIV infection, western and central Africa is the second most affected region world-wide, and the gap between the regional figures for the testing and treatment cascade and the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets is particularly worrying. We assessed the prevalence of virological suppression in patients routinely treated in 19 hospitals in Cameroon.
A cross-sectional survey was performed in adult patients receiving antiretroviral therapy (ART) in the Centre and Littoral regions. The prevalences of virological suppression (<1000 HIV-1 RNA copies/mL) were compared among all 19 hospitals using the χ test. Potential individual and health care-related determinants of virological suppression were assessed using multivariate logistic regression models.
A total of 1700 patients (74% women; median age 41 years; median time on ART 3.7 years) were included in the study. The prevalence of virological suppression was 82.4% overall (95% confidence interval 80.5-84.2%). It ranged from 57.1 to 97.4% according to the individual hospital (P < 0.001). After adjustment, virological suppression was associated with age, CD4 cell count at ART initiation, disclosure of HIV status to family members, interruption of ART for more than two consecutive days, and location of patient's residence and hospital (rural/urban). These factors did not explain the heterogeneity of virological suppression between the study hospitals (P < 0.001).
The overall prevalence of virological suppression was reassuring. Nevertheless, the heterogeneity of virological suppression among hospitals highlights that, in addition to programme-level data, health facility-level data are crucial in order to tailor the national AIDS programme's interventions with a view to achieving the third UNAIDS 90 target.
就艾滋病毒感染而言，西部和中部非洲是全球受影响第二严重的地区，该地区的检测和治疗连续体以及联合国艾滋病规划署（艾滋病署）90-90-90 目标之间的差距尤其令人担忧。我们评估了喀麦隆 19 家医院常规治疗的患者中病毒学抑制的流行率。
在中心和滨海地区接受抗逆转录病毒疗法（ART）的成年患者中进行了横断面调查。使用卡方检验比较了所有 19 家医院的病毒学抑制率（<1000 HIV-1 RNA 拷贝/ml）。使用多变量逻辑回归模型评估了个体和与卫生保健相关的病毒学抑制的潜在决定因素。
共纳入 1700 名患者（74%为女性；中位年龄 41 岁；中位 ART 时间为 3.7 年）。总体上，病毒学抑制的流行率为 82.4%（95%置信区间 80.5-84.2%）。根据各医院的不同，该比率从 57.1%到 97.4%不等（P<0.001）。调整后，病毒学抑制与年龄、ART 起始时的 CD4 细胞计数、向家庭成员透露艾滋病毒状况、连续两天以上中断 ART 以及患者居住地和医院的位置（农村/城市）有关（P<0.001）。这些因素不能解释研究医院之间病毒学抑制的异质性（P<0.001）。
总体而言，病毒学抑制的流行率令人安心。然而，各医院之间病毒学抑制的异质性突出表明，除了方案层面的数据外，卫生机构层面的数据对于调整国家艾滋病方案的干预措施以实现艾滋病署第三个 90 目标至关重要。
