City of Harare Health Services Department, Harare, Zimbabwe.
Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France.
PLoS One. 2019 Feb 5;14(2):e0211326. doi: 10.1371/journal.pone.0211326. eCollection 2019.
In people living with HIV (PLHIV) who are on anti-retroviral therapy (ART), it is essential to identify persons with high blood viral loads (VLs) (≥1000 copies/ml), provide enhanced adherence counselling (EAC) for 3 months and assess for VL suppression (<1000 copies/ml).
Our study objectives were to determine the proportion who had a high viral load in those people who underwent viral load testing between 1 August 2016-31 July 2017 at Wilkins Hospital, Harare, Zimbabwe. Of those with high viral load to assess; a) the proportion who enrolled for EAC, the demographic and clinical characteristics associated with enrolment for EAC and, b) the proportion who achieved viral load suppression and demographic, clinical characteristics associated with viral load suppression.
Retrospective cohort study using routinely collected programme data. Data was collected from PLHIV who were on ART and had a high viral load from 1 August 2016 to 31 July 2017.
Of 5,573 PLHIV on ART between 1 August 2016 and 31 July 2017, 4787 (85.9%) had undergone VL testing and 646 (13.5%) had high VLs. Of these 646, only 489 (75.7%) were enrolled for EAC, of whom 444 (69%) underwent a repeat VL test at ≥ 3 months with 201 (31.2%) achieving VL suppression. The clinical characteristics that were independently associated with higher probability of VL suppression were: a) undergoing 3 sessions of EAC; b) being on 2nd line ART. Initial VL levels >5,000 copies/ml were associated with lower probability of viral suppression.
The routine VL testing levels were high, but there were major programmatic gaps in enrolling PLHIV with high VLs into EAC and achieving VL suppression. The full potential of EAC on achieving viral load suppression has not been achieved in this setting. The reasons for these gaps need to be assessed in future research studies and addressed by suitable changes in policies/practices.
在接受抗逆转录病毒治疗（ART）的艾滋病毒感染者（PLHIV）中，识别病毒载量高（VL）（≥1000 拷贝/毫升）的人，提供强化依从性咨询（EAC）三个月，并评估病毒载量抑制（<1000 拷贝/毫升）是至关重要的。
我们的研究目的是确定在津巴布韦哈拉雷威尔金斯医院 2016 年 8 月 1 日至 2017 年 7 月 31 日期间接受病毒载量检测的人中有多少人病毒载量高。对于那些病毒载量高的人，评估：a）接受 EAC 的比例，与接受 EAC 相关的人口统计学和临床特征，以及 b）实现病毒载量抑制的比例，以及与病毒载量抑制相关的人口统计学和临床特征。
使用常规收集的方案数据进行回顾性队列研究。数据来自于接受 ART 治疗且病毒载量高的 PLHIV，时间为 2016 年 8 月 1 日至 2017 年 7 月 31 日。
在 2016 年 8 月 1 日至 2017 年 7 月 31 日期间接受 ART 治疗的 5573 名 PLHIV 中，有 4787 名（85.9%）接受了 VL 检测，有 646 名（13.5%）病毒载量高。在这 646 人中，只有 489 人（75.7%）接受了 EAC 咨询，其中 444 人（69%）在至少 3 个月后进行了重复 VL 检测，其中 201 人（31.2%）实现了 VL 抑制。与更高的 VL 抑制概率独立相关的临床特征是：a）接受 3 次 EAC 咨询；b）接受二线 ART。初始 VL 水平>5000 拷贝/毫升与病毒抑制的可能性较低有关。
常规 VL 检测水平较高，但在将高 VL 艾滋病毒感染者纳入 EAC 咨询和实现 VL 抑制方面存在重大方案差距。在这种情况下，EAC 实现病毒载量抑制的全部潜力尚未得到发挥。需要在未来的研究中评估这些差距的原因，并通过政策/实践的适当改变加以解决。
