Uganda Virus Research Institute, Entebbe, Uganda.
Uganda AIDS Control Programme, Ministry of Health, Kampala, Uganda.
PLoS One. 2020 Apr 14;15(4):e0230451. doi: 10.1371/journal.pone.0230451. eCollection 2020.
With the scale-up of antiretroviral therapy (ART) there is a need to monitor programme performance to maximize ART efficacy and to prevent emergence of HIV drug resistance (HIVDR). In keeping with the elements of the World Health Organisation (WHO) guidance we carried out a nationally representative assessment of early warning indicators (EWI) at 304 randomly selected ART service outlets in Uganda.
Retrospective patient data was extracted for the six EWIs for HIVDR including; on-time antiretroviral (ARV) drug pick-up, patient retention on ART at 12 months, ART dispensing practices, ARV drug stock-outs, viral load suppression (VLS) and viral load (VL) testing completion. Point prevalence for each clinic and national aggregate prevalence with 95% confidence intervals (CI) for all clinics were estimated and facility performances were computed and association between EWIs and programmatic factors assessed using Fisher's Exact Test.
Facilities meeting the EWI targets: on-time pill pick-up was 9.5%, more facilities in the north met this target (p = 0.040). Retention on ART at 12 months was 24.1%, facilities in Kampala region (p<0.001) and Specialized ART clinics (p = 0.01) performed better in this indicator. Pharmacy stock-outs was 33.6%, with more facilities in Kampala (p<0.001), specialized ART clinics (p<0.001) and private-for-profit (p<0.001) meeting this target. Dispensing practices was met by 100% of the facilities. VLS was met by 49.2% and 50.8% of facilities met VL completion target with facilities in central region performing better (p<0.001). National prevalence for the EWIs was: on-time pill pick-up 63.3% (CI: 58.9-67.8); retention on ART at 12 months 69.9% (CI: 63.8-76.0); dispensing practices 100.0%; VLS 85.2% (CI: 81.8-88.5) and VL completion, 60.7% (CI: 56.9-64.6).
Dispensing practices in all facilities were in line with the national guidelines however, there still remains a challenge to long-term ART programmatic success in monitoring patient response to treatment, and maintaining patients on ART without interruptions arising due to poor patient adherence and as a consequence of ARV supply interruption. It is therefore of high importance that the national ART program ensures intensified follow-up for patients, ensuring uninterrupted supply of ARV drugs and increasing VL monitoring at treatment centres, in order to improve patient outcomes and avert preventable HIVDR.
随着抗逆转录病毒疗法（ART）规模的扩大，需要监测项目绩效，以最大限度地提高 ART 疗效，并预防 HIV 耐药性（HIVDR）的出现。为了符合世界卫生组织（WHO）指南的要素，我们在乌干达的 304 个随机选择的 ART 服务点对早期预警指标（EWI）进行了全国代表性评估。
回顾性提取了包括以下六个 HIVDR 早期预警指标的患者数据：按时接受抗逆转录病毒（ARV）药物；12 个月时患者在 ART 上的保留率；ART 配发实践；ARV 药物缺货；病毒载量抑制（VLS）和病毒载量（VL）检测完成情况。估计每个诊所的时点患病率和所有诊所的全国综合患病率及其 95%置信区间（CI），计算设施绩效，并使用 Fisher 精确检验评估 EWI 与项目因素之间的关联。
符合 EWI 目标的设施：按时服药率为 9.5%，北部的设施更符合这一目标（p = 0.040）。12 个月时的 ART 保留率为 24.1%，坎帕拉地区的设施（p<0.001）和专门的 ART 诊所（p = 0.01）在这一指标上表现更好。药房缺货率为 33.6%，坎帕拉（p<0.001）、专门的 ART 诊所（p<0.001）和私立营利性诊所（p<0.001）的设施更符合这一目标。100%的设施符合配发实践要求。VLS 达到 49.2%，50.8%的设施达到 VL 完成目标，中部地区的设施表现更好（p<0.001）。全国 EWI 的流行率为：按时服药率为 63.3%（CI：58.9-67.8）；12 个月时的 ART 保留率为 69.9%（CI：63.8-76.0）；配发实践为 100.0%；VLS 为 85.2%（CI：81.8-88.5），VL 完成率为 60.7%（CI：56.9-64.6）。
所有设施的配发实践都符合国家指南，但在监测患者对治疗的反应并保持患者不间断接受 ART 治疗方面，长期 ART 项目的成功仍然面临挑战，这是由于患者服药依从性差以及 ARV 供应中断造成的。因此，国家 ART 项目确保加强对患者的随访，确保 ARV 药物的不间断供应，并增加治疗中心的 VL 监测，以改善患者的治疗效果，避免可预防的 HIVDR，这一点非常重要。
