Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.
Departments of Epidemiology; and.
J Acquir Immune Defic Syndr. 2020 Dec 15;85(5):606-611. doi: 10.1097/QAI.0000000000002498.
Repeat HIV viral load (VL) testing is required after unsuppressed VL to confirm treatment failure. We assessed proportion of adolescents and young adults living with HIV (AYALHIV) in Kenya with a confirmatory VL test and time to repeat testing.
A retrospective analysis of longitudinal data abstracted from Kenya's national VL database.
VL data for AYALHIV who were 10-24 year old between April 2017 and May 2019 were abstracted from 117 HIV care clinics. Records were eligible if at least one VL test was performed ≥6 months after antiretroviral therapy (ART) initiation. The proportion of unsuppressed AYALHIV (≥1000 copies/mL) and time in months between first unsuppressed VL and repeat VL was determined.
We abstracted 40,928 VL records for 23,969 AYALHIV; of whom, 17,092 (71%) were eligible for this analysis. Of these, 12,122 (71%) were women, median age of 19 years [interquartile range (IQR): 13-23], and median ART duration of 38 months (IQR: 16-76). Among eligible AYALHIV, 4010 (23%) had an unsuppressed VL at first eligible measurement. Only 316 (8%) of the unsuppressed AYALHIV had a repeat VL within 3 months and 1176 (29%) within 6 months. Among 2311 virally unsuppressed AYALHIV with a repeat VL, the median time between the first and the repeat VL was 6 months (IQR: 4-8), with 1330 (58%) having confirmed treatment failure.
One-quarter of AYALHIV on ART had unsuppressed VL, with less than a third receiving a repeat VL within 6 months. Strategies to improve VL testing practices are needed to improve AYALHIV's outcomes.
在未抑制的病毒载量（VL）后需要重复 HIV VL 检测以确认治疗失败。我们评估了肯尼亚的青少年和年轻成人 HIV 感染者（AYALHIV）中有多少人进行了确认性 VL 检测以及重复检测的时间。
从肯尼亚国家 VL 数据库中提取的纵向数据的回顾性分析。
从 2017 年 4 月至 2019 年 5 月期间 10-24 岁的 117 个 HIV 护理诊所中提取了 AYALHIV 的 VL 数据。如果至少进行了一次 VL 检测，且在抗逆转录病毒治疗（ART）开始后≥6 个月，则记录符合条件。确定未受抑制的 AYALHIV（≥1000 拷贝/ml）的比例以及首次未受抑制的 VL 与重复 VL 之间的时间（以月为单位）。
我们提取了 40928 份 VL 记录，涉及 23969 名 AYALHIV；其中 17092 名（71%）符合本分析条件。在这些患者中，12122 名（71%）为女性，中位年龄 19 岁[四分位距（IQR）：13-23]，ART 中位时长为 38 个月（IQR：16-76）。在符合条件的 AYALHIV 中，有 4010 名（23%）在首次有资格进行测量时的 VL 未受抑制。仅有 316 名（8%）未受抑制的 AYALHIV 在 3 个月内进行了重复 VL 检测，1176 名（29%）在 6 个月内进行了重复 VL 检测。在 2311 名有重复 VL 的 VL 未受抑制的 AYALHIV 中，首次和重复 VL 之间的中位时间为 6 个月（IQR：4-8），其中 1330 名（58%）确诊治疗失败。
接受 ART 的 AYALHIV 中有四分之一的 VL 未受抑制，不到三分之一的人在 6 个月内接受了重复 VL 检测。需要制定策略来改善 VL 检测实践，以改善 AYALHIV 的结局。
