坦桑尼亚中部多多马市艾滋病毒/艾滋病护理和治疗诊所接受抗逆转录病毒治疗的儿童和青少年中病毒学治疗失败的患病率及相关因素

Prevalence and Factors Associated With Virological Treatment Failure Among Children and Adolescents on Antiretroviral Therapy Attending HIV/AIDS Care and Treatment Clinics in Dodoma Municipality, Central Tanzania.

作者信息

Bitwale Niyonziza Z, Mnzava David P, Kimaro Francisca D, Jacob Theopista, Mpondo Bonaventura C T, Jumanne Shakilu

机构信息

Department of Paediatrics & Child Health, University of Dodoma, Dodoma, Tanzania.

Department of Paediatrics & Child Health, Dodoma Regional Referral Hospital, Dodoma, Tanzania.

出版信息

J Pediatric Infect Dis Soc. 2021 Mar 26;10(2):131-140. doi: 10.1093/jpids/piaa030.

DOI:10.1093/jpids/piaa030

PMID:32463083

Abstract

BACKGROUND

As the World Health Organization (WHO) and its joint partners such as USAIDS target achieving 90% sustained virological suppression among children and adolescents living with Human Immunodeficience Virus (HIV)/AIDS, it is imperative to elucidate the current prevalence and factors associated with virological treatment failure for formulation of appropriate strategies. This study was conducted determine the prevalence and factors associated with virological treatment failure among children and adolescents with HIV/AIDS on antiretroviral therapy (ART) attending HIV/AIDS care clinics in Dodoma, Central Tanzania.

METHODS

This was a cross-sectional study of children aged 1-19 years attending 3 HIV/AIDS care clinics in Dodoma (central Tanzania) from November 2018 to February 2019. Sociodemographic and clinical factors were documented, HIV viral load and CD4+ T lymphocytes were evaluated for children on ART for ≥6 months. The primary outcomes were the prevalence and factors associated with viralogic treatment failure.

RESULTS

Of 300 children enrolled, 102 (34%) had virological treatment failure. Poor adherence to ART (adjusted odds ratio [AOR] = 3.221; 95% confidence interval [CI], 1.867-5.558; P = .032), nevirapine regimen (AOR = 3.185; 95% CI, 1.473-6.886; P ≤ .001), not using cotrimoxazole prophylaxis (AOR = 25.56; 95% CI, 3.15-27.55; P = .002) and nondisclosure of HIV status to others (AOR = 7.741; 95% CI, 2.351-25.489; P = .001) were independently associated with virological treatment failure.

CONCLUSIONS

Current prevalence of virological treatment failure among children and adolescents living with HIV on ART remain high. Factors such as ART adherence, nevirapine based regimen, HIV status disclosure to those caring for the child need to be addressed to achieve sustained virological suppression.

摘要

背景

随着世界卫生组织（WHO）及其联合伙伴（如美国国际开发署）的目标是让感染人类免疫缺陷病毒（HIV）/艾滋病的儿童和青少年中90%实现持续病毒学抑制，阐明当前的患病率以及与病毒学治疗失败相关的因素对于制定适当策略至关重要。本研究旨在确定在坦桑尼亚中部多多马的HIV/艾滋病护理诊所接受抗逆转录病毒治疗（ART）的HIV/艾滋病儿童和青少年中病毒学治疗失败的患病率及相关因素。

方法

这是一项横断面研究，研究对象为2018年11月至2019年2月期间在多多马（坦桑尼亚中部）3家HIV/艾滋病护理诊所就诊的1至19岁儿童。记录社会人口统计学和临床因素，对接受ART≥6个月的儿童评估HIV病毒载量和CD4 + T淋巴细胞。主要结局是病毒学治疗失败的患病率及相关因素。

结果

在纳入的300名儿童中，102名（34%）出现病毒学治疗失败。抗逆转录病毒治疗依从性差（调整优势比[AOR]=3.221；95%置信区间[CI]，1.867 - 5.558；P = 0.032）、奈韦拉平治疗方案（AOR = 3.185；95% CI，1.473 - 6.886；P≤0.001）、未使用复方新诺明预防（AOR = 25.56；95% CI，3.15 - 27.55；P = 0.002）以及未向他人透露HIV感染状况（AOR = 7.741；95% CI，2.351 - 25.489；P = 0.001）与病毒学治疗失败独立相关。