Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States of America.
International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, MO, United States of America.
PLoS One. 2020 Feb 10;15(2):e0228370. doi: 10.1371/journal.pone.0228370. eCollection 2020.
The rapid scale-up of HIV therapy across Africa has failed to adequately engage adolescents living with HIV (ALWHIV). Retention and viral suppression for this group (ALWHIV) is 50% lower than for adults. Indeed, on the African continent, HIV remains the single leading cause of mortality among adolescents. Strategies tailored to the unqiue developmental and social vulnerabilities of this group are urgently needed to enhance successful treatment.
We carried out a five-year longitudinal cluster randomized trial (ClinicalTrials.gov ID: NCT01790373) with adolescents living with HIV (ALWHIV) ages 10 to 16 years clustered at health care clinics to test the effect of a family economic empowerment (EE) intervention on viral suppression in five districuts in Uganda. In total, 39 accredited health care clinics from study districts with existing procedures tailored to adolescent adherence were eligible to participate in the trial. We used data from 288 youth with detectable HIV viral loads (VL) at baseline (158 -intervention group from 20 clinics, 130 -non-intervention group from 19 clinics). The primary end point was undetectable plasma HIV RNA levels, defined as < 40 copies/ml. We used Kaplan-Meier (KM) analysis and Cox proportional hazard models to estimate intervention effects.
The Kaplan-Meier (KM) analysis indicated that an incidence of undetectable VL (0.254) was significantly higher in the intervention condition compared to 0.173 (in non-intervention arm) translated into incidence rate ratio of 1.468 (CI: 1.064-2.038), p = 0.008. Cox regression results showed that along with the family-based EE intervention (adj. HR = 1.446, CI: 1.073-1.949, p = 0.015), higher number of medications per day had significant positive effects on the viral suppression (adj.HR = 1.852, CI: 1.275-2.690, p = 0.001).
A family economic empowerment intervention improved treatment success for ALWHIV in Uganda. Analyses of cost effectiveness and scalability are needed to advance incorporation of this intervention into routine practice in low and middle-income countries.
非洲艾滋病毒治疗的快速扩大未能充分让感染艾滋病毒的青少年（ALWHIV）参与进来。该群体（ALWHIV）的保留率和病毒抑制率比成年人低 50%。事实上，在非洲大陆，艾滋病毒仍然是青少年死亡的单一主要原因。迫切需要针对该群体独特的发展和社会脆弱性制定专门战略，以提高治疗的成功率。
我们开展了一项为期五年的纵向集群随机试验（临床试验.gov 标识符：NCT01790373），将年龄在 10 至 16 岁的感染艾滋病毒的青少年（ALWHIV）聚集在医疗保健诊所，以测试家庭经济赋权（EE）干预对乌干达五个地区艾滋病毒抑制的影响。共有来自研究地区的 39 个合格的医疗保健诊所参与了试验，这些诊所具有针对青少年坚持治疗的现有程序。我们使用了 288 名基线时可检测到 HIV 病毒载量（VL）的青年的数据（158 名 - 干预组来自 20 个诊所，130 名 - 非干预组来自 19 个诊所）。主要终点是检测不到的血浆 HIV RNA 水平，定义为 < 40 拷贝/ml。我们使用 Kaplan-Meier（KM）分析和 Cox 比例风险模型来估计干预效果。
Kaplan-Meier（KM）分析表明，干预条件下不可检测到 VL 的发生率（0.254）明显高于对照条件下的 0.173（非干预组），换算成发病率比为 1.468（CI：1.064-2.038），p = 0.008。Cox 回归结果表明，随着以家庭为基础的 EE 干预（调整后 HR = 1.446，CI：1.073-1.949，p = 0.015），每天服用的药物数量越多，对病毒抑制有显著的积极影响（调整后 HR = 1.852，CI：1.275-2.690，p = 0.001）。
乌干达的家庭经济赋权干预措施提高了感染艾滋病毒的青少年的治疗成功率。需要进行成本效益和可扩展性分析，以便将这一干预措施纳入中低收入国家的常规实践。
