评估肯尼亚青少年艾滋病毒关怀包（APOC）培训对病毒载量抑制的效果。

Evaluating the effectiveness of the HIV adolescent package of care (APOC) training on viral load suppression in Kenya.

机构信息

Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Kenya.

Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, CA, USA.

出版信息

Public Health. 2019 Aug;173:146-149. doi: 10.1016/j.puhe.2019.05.026. Epub 2019 Jul 13.

DOI:10.1016/j.puhe.2019.05.026

PMID:31310874

Abstract

OBJECTIVES

To evaluate the effectiveness of the implementation of the adolescent package of care (APOC) training on adolescent viral suppression at Family AIDS Care & Education Services (FACES)-supported sites.

STUDY DESIGN

The effect of APOC training was evaluated based on viral load suppression (<1000 copies/mL) of 10-19-year-olds in 13 FACES-supported sites in six months before (January 2015-August 2016) and after (November 2015-March 2017) the APOC training for each site.

METHODS

Patient-level data were abstracted from the FACES electronic medical records (OpenMRS) and the National AIDS and STI Control Programme viral load website. Information on adolescent clinic day implementation and utilization of an APOC checklist as a proxy for services provided at each site was collected. Generalized estimating equations with repeated measures clustered by patients were used for bivariate and multivariate modeling to assess factors associated with viral suppression.

RESULTS

In the pretraining period, 60% of adolescents received services at clinics offering adolescent clinic days compared to 95% in the post-training period. Among those tested, 65% were virally suppressed during the pretraining period compared to 72% during the post-training period (odds ratio [OR] = 1.31, 95% confidence interval [CI] 1.12, 1.53, P < 0.01). In multivariable analysis, there was no statistically significant change in viral load suppression due to APOC training (adjusted OR [aOR] = 0.97, 95% CI: 0.72, 1.30, P = 0.84). However, at clinics offering adolescent-friendly clinic days, adolescents were nearly 2 times more likely to be virally suppressed than at facilities not offering these specialized clinic days (aOR = 1.86, 95% CI: 1.04, 3.32, P = 0.04).

CONCLUSIONS

This study suggests that adolescent clinic days greatly improve adolescent viral load suppression and should be considered for implementation across HIV programs.

摘要

目的

评估在家庭艾滋病关爱与教育服务（FACES）支持的场所实施青少年护理套餐（APOC）培训对青少年病毒抑制的效果。

研究设计

根据 APOC 培训前后（2015 年 1 月至 2016 年 8 月和 2015 年 11 月至 2017 年 3 月）各场所的青少年病毒载量抑制情况（<1000 拷贝/毫升），评估 APOC 培训的效果。

方法

从 FACES 电子病历（OpenMRS）和国家艾滋病和性传播感染控制规划病毒载量网站中提取患者水平数据。收集有关青少年诊所日实施情况和使用 APOC 检查表（作为各场所提供服务的代理）的信息。采用广义估计方程对患者进行重复测量聚类进行双变量和多变量建模，以评估与病毒抑制相关的因素。

结果

在培训前，60%的青少年在提供青少年诊所日的诊所接受服务，而在培训后，这一比例上升至 95%。在接受检测的青少年中，培训前的病毒抑制率为 65%，培训后的病毒抑制率为 72%（比值比[OR] = 1.31，95%置信区间[CI] 1.12，1.53，P < 0.01）。在多变量分析中，APOC 培训并没有导致病毒载量抑制的统计学显著变化（调整后的比值比[aOR] = 0.97，95%CI：0.72，1.30，P = 0.84）。然而，在提供青少年友好诊所日的诊所，青少年的病毒抑制率几乎是未提供这些专门诊所日的设施的两倍（aOR = 1.86，95%CI：1.04，3.32，P = 0.04）。