Makerere University-Johns Hopkins University Research Collaboration; Makerere University College of Health Sciences - School of Public Health.
Makerere University-Johns Hopkins University Research Collaboration.
Int J Infect Dis. 2021 Mar;104:526-531. doi: 10.1016/j.ijid.2021.01.005. Epub 2021 Jan 9.
Timely viral load (VL) testing is critical in the care of pregnant women living with HIV and receiving anti-retroviral therapy (ART). There is paucity of data regarding the Time to First Viral Load (TFVL) testing in resource-limited settings.
We extracted clinical and VL test data from records of a cohort of ART-naïve pregnant women living with HIV who initiated Option B + and were retained in care between 01 Jan 2015 and 31 Dec 2015. The data were verified against laboratory VL registers. TFVL (in months) was calculated based on the time difference between the date of ART initiation and FVL test. Descriptive and Cox regression analyses of data up to 30 Sep 2017 (33 months later) were done.
Of the 622 records retrieved, 424 women were retained in care. Of 424 women retained in care, 182/424 (43%) had at least one VL result post ART initiation while 242/424 (57%) had no VL performed. Only 30/182 (16.5%) had a second VL. At six, nine, and twelve months, only 8/424 (1.9%), 47/424 (11.1%), and 94/424 (22.2%) had VL testing performed respectively post ART initiation. The median TFVL testing was 12.7 months (95 CI 11.6-13.7) post ART initiation. Across the five clinics, patient factors (age, gravidity, gestational age, marital status, and adherence at 12 months) were not significant predictors.
A dismal 1.9% rate of achieving WHO-recommended TFVL testing and a median TFVL testing of twelve months post ART initiation were observed. The non-association of patient factors to these observations may suggest a serious need to review health system factors likely associated with these observations and their effective interventions.
及时进行病毒载量（VL）检测对于接受抗逆转录病毒疗法（ART）的 HIV 感染孕妇的护理至关重要。在资源有限的环境中，关于首次病毒载量（TFVL）检测时间的数据很少。
我们从 2015 年 1 月 1 日至 2015 年 12 月 31 日期间开始接受 Option B+的、接受 ART 的 HIV 感染孕妇队列的记录中提取了临床和 VL 检测数据，并对其进行了保留。数据与实验室 VL 登记册进行了核对。TFVL（以月为单位）是根据 ART 开始日期与 FVL 检测日期之间的时间差计算得出的。截至 2017 年 9 月 30 日（33 个月后）进行了数据的描述性和 Cox 回归分析。
从检索到的 622 份记录中，有 424 名妇女得到了保留。在接受保留护理的 424 名妇女中，有 182/424（43%）在接受 ART 后至少有一次 VL 结果，而 242/424（57%）没有进行 VL 检测。仅有 30/182（16.5%）进行了第二次 VL 检测。在接受 ART 后六个月、九个月和十二个月时，分别只有 8/424（1.9%）、47/424（11.1%）和 94/424（22.2%）进行了 VL 检测。ART 后中位 TFVL 检测时间为 12.7 个月（95%CI 11.6-13.7）。在五个诊所中，患者因素（年龄、孕次、孕龄、婚姻状况和 12 个月时的依从性）并不是显著的预测因素。
观察到实现世卫组织建议的 TFVL 检测的比例低至 1.9%，ART 后中位数 TFVL 检测时间为 12 个月。这些观察结果与患者因素无关，这可能表明需要认真审查可能与这些观察结果及其有效干预措施相关的卫生系统因素。
