Pact, P.O. Box 6348, Dar es Salaam, Tanzania.
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BMC Public Health. 2020 Aug 17;20(1):1251. doi: 10.1186/s12889-020-09361-6.
Utilization of antiretroviral therapy (ART) is crucial for better health outcomes among people living with the human immunodeficiency virus (PLHIV). Nearly 30% of the 1.6 million PLHIV in Tanzania are not on treatment. Since HIV positive status is the only eligibility criterion for ART use, it is critical to understand the obstacles to ART access and uptake to reach universal coverage of ART among PLHIV. For the caregivers of orphans and vulnerable children (OVC) LHIV and not on ART, attempts to identify them and ensure that they initiate and continue using ART is critical for their wellbeing and their ability to care for their children.
Data are from the community-based, United States Agency for International Development (USAID)-funded Kizazi Kipya project that aims at scaling up the uptake of HIV/AIDS and other health and social services by orphans and vulnerable children (OVC) and their caregivers. HIV positive caregivers of OVC who were enrolled in the USAID Kizazi Kipya project between January 2017 and June 2018 were included in this cross-sectional study. The caregivers were drawn from 11 regions: Arusha, Iringa, Katavi, Kigoma, Mara, Mbeya, Morogoro, Ruvuma, Simiyu, Singida, and Tanga. The outcome variable was ART status (either using or not), which was enquired of each OVC caregiver LHIV at enrollment. Data analysis involved multivariable analysis using random-effects logistic regression to identify correlates of ART use.
In total, 74,999 caregivers living with HIV with mean age of 44.4 years were analyzed. Of these, 96.4% were currently on ART at enrollment. In the multivariable analysis, ART use was 30% lower in urban than in rural areas (adjusted odds ratio (OR) = 0.70, 95% confidence interval (CI) 0.61-0.81). Food security improved the odds of being on ART (OR = 1.29, 95% CI 1.15-1.45). Disabled caregivers were 42% less likely than non-disabled ones to be on ART (OR = 0.58, 95% CI 0.45-0.76). Male caregivers with health insurance were 43% more likely than uninsured male caregivers to be on ART (OR = 1.43, 95% CI 1.11-1.83). Caregivers aged 40-49 years had 18% higher likelihood of being on ART than the youngest ones. Primary education level was associated with 26% increased odds of being on ART than no education (OR = 1.26, 95% CI 1.13-1.41).
Although nearly all the caregivers LHIV in the current study were on ART (96.4%), more efforts are needed to achieve universal coverage. The unreached segments of the population LHIV, even if small, may lead to worse health outcomes, and also spur further spread of the HIV epidemic due to unachieved viral suppression. Targeting caregivers in urban areas, food insecure households, who are uninsured, and those with mental or physical disability can improve ART coverage among caregivers LHIV.
抗逆转录病毒疗法（ART）的利用对于艾滋病毒感染者（PLHIV）的健康结果至关重要。坦桑尼亚的 160 万 PLHIV 中，近 30%未接受治疗。由于 HIV 阳性是使用 ART 的唯一资格标准，因此了解获得 ART 的障碍和采用率对于实现 PLHIV 中 ART 的普遍覆盖至关重要。对于未接受抗逆转录病毒治疗的孤儿和弱势儿童（OVC）的 HIV 阳性照顾者，尝试确定他们并确保他们开始并继续使用 ART，这对于他们的健康和照顾孩子的能力至关重要。
数据来自基于社区的美国国际开发署（USAID）资助的 Kizazi Kipya 项目，该项目旨在通过孤儿和弱势儿童（OVC）及其照顾者来扩大艾滋病毒/艾滋病和其他卫生及社会服务的获取。在 2017 年 1 月至 2018 年 6 月期间参加美国国际开发署 Kizazi Kipya 项目的 HIV 阳性 OVC 照顾者被纳入本横断面研究。这些照顾者来自 11 个地区：阿鲁沙、伊林加、卡塔维、基戈马、马腊、姆贝亚、莫罗戈罗、鲁伍马、西米尤、欣延加和坦噶。结局变量是 ART 状况（使用或不使用），在登记时询问每个 OVC 照顾者的 HIV 阳性者。数据分析包括使用随机效应逻辑回归的多变量分析，以确定 ART 使用的相关性。
总共分析了 74999 名平均年龄为 44.4 岁的 HIV 阳性照顾者。其中，96.4%的人在登记时正在使用 ART。在多变量分析中，城市地区的 ART 使用率比农村地区低 30%（调整后的优势比（OR）=0.70，95%置信区间（CI）0.61-0.81）。粮食安全改善了接受 ART 的可能性（OR=1.29，95%CI 1.15-1.45）。残疾照顾者使用 ART 的可能性比非残疾照顾者低 42%（OR=0.58，95%CI 0.45-0.76）。有医疗保险的男性照顾者使用 ART 的可能性比没有医疗保险的男性照顾者高 43%（OR=1.43，95%CI 1.11-1.83）。40-49 岁的照顾者使用 ART 的可能性比最年轻的照顾者高 18%。与没有教育程度的人相比，接受过小学教育的人使用 ART 的可能性增加了 26%（OR=1.26，95%CI 1.13-1.41）。
尽管目前研究中的大多数 HIV 阳性照顾者（96.4%）都在使用 ART，但仍需要做出更多努力来实现普遍覆盖。即使是人口中未被覆盖的小部分 HIV 阳性者，也可能导致健康结果恶化，并由于未实现病毒抑制而进一步助长艾滋病毒疫情的蔓延。针对城市地区、粮食不安全家庭、没有保险的和有精神或身体残疾的照顾者，可以提高 HIV 阳性照顾者的 ART 覆盖率。
