School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa.
S Afr Med J. 2020 Nov 27;110(12):1213-1217. doi: 10.7196/SAMJ.2020.v110i12.14509.
BACKGROUND: In 2018, 4% of all people living with HIV globally were adolescents aged 10 - 19 years. It is reported that adolescents on antiretroviral therapy (ART) are at increased risk of poor viral load suppression (VLS) compared with children and adults. OBJECTIVES: To determine the 24-month prevalence of VLS among adolescents initiated on ART in 2013 in public health facilities in the Metro District Health Services of Western Cape Province, South Africa. METHODS: A retrospective cohort analysis was done on 220 adolescents initiated on ART in 2013; they were followed up for 24 months. Data were extracted from the provincial Tier.Net electronic database and patients' clinical records, and captured in Excel. SPSS statistical software was used for descriptive and inferential analysis; bivariate analysis was used to determine significance and strength of associations between VLS and various sociodemographic and clinical characteristics at 4, 12 and 24 months (with significance set at p<0.05). RESULTS: VLS declined over the study period, with rates of 59.5%, 40.0% and 25.0% at 4, 12 and 24 months post initiation on treatment, respectively. In bivariate analysis, VLS was significantly associated with younger age (10 - 14 years) at month 12 (crude risk ratio (RR) 1.83 (95% confidence interval (CI) 1.35 - 2.49)) and month 24 (RR 3.38 (95% CI 2.24 - 5.10)) after initiation on ART. Male adolescents were significantly more likely to achieve VLS than females (month 4: RR 1.49 (95% CI 1.22 - 1.81); month 12: RR 1.50 (95% CI 1.07 - 2.12); and month 24: RR 2.33 (95% CI 1.50 - 3.62)). Pregnant adolescents were significantly less likely to attain VLS (month 4: RR 0.69 (95% CI 0.53 - 0.89); month 12: RR 0.64 (95% CI 0.44 - 0.94); and month 24: RR 0.24 (95% CI 0.11 - 0.50)) compared with those who were not pregnant. However, of those adolescents who were retained in care, VLS was higher at months 4, 12 and 24, with rates of 86.8%, 79.3% and 68.8%, respectively. CONCLUSIONS: Targeted interventions are required to improve retention in care and VLS among adolescents on ART, with specific focus on older (15 - 19-year-olds) and pregnant adolescents.
背景：2018 年，全球所有 HIV 感染者中有 4%为 10-19 岁的青少年。据报道，与儿童和成年人相比，接受抗逆转录病毒治疗（ART）的青少年病毒载量抑制不佳（VLS）的风险更高。
目的：确定 2013 年在南非西开普省都会区卫生服务部的公共卫生机构中开始接受 ART 的青少年在 24 个月时的 VLS 患病率。
方法：对 2013 年开始接受 ART 的 220 名青少年进行回顾性队列分析；他们被随访了 24 个月。数据从省级 Tier.Net 电子数据库和患者的临床记录中提取出来，并在 Excel 中进行了捕获。使用 SPSS 统计软件进行描述性和推断性分析；使用双变量分析在 4、12 和 24 个月时确定 VLS 与各种社会人口统计学和临床特征之间的显著性和关联强度（显著性设为 p<0.05）。
结果：在研究期间，VLS 呈下降趋势，分别在治疗开始后 4、12 和 24 个月时的 VLS 率为 59.5%、40.0%和 25.0%。在双变量分析中，VLS 在治疗开始后 12 个月（未校正风险比（RR）1.83（95%置信区间（CI）1.35-2.49））和 24 个月（RR 3.38（95%CI 2.24-5.10））时与年龄较小（10-14 岁）显著相关。与女性相比，男性青少年更有可能实现 VLS（第 4 个月：RR 1.49（95%CI 1.22-1.81）；第 12 个月：RR 1.50（95%CI 1.07-2.12）；第 24 个月：RR 2.33（95%CI 1.50-3.62））。与未怀孕的青少年相比，怀孕的青少年获得 VLS 的可能性明显较低（第 4 个月：RR 0.69（95%CI 0.53-0.89）；第 12 个月：RR 0.64（95%CI 0.44-0.94）；第 24 个月：RR 0.24（95%CI 0.11-0.50））。然而，在那些保留在护理中的青少年中，VLS 在第 4、12 和 24 个月时更高，分别为 86.8%、79.3%和 68.8%。
结论：需要针对接受 ART 的青少年开展有针对性的干预措施，以提高其护理保留率和 VLS，特别关注年龄较大（15-19 岁）和怀孕的青少年。
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