Department of Social Policy and Intervention, University of Oxford, 32 Wellington Square, Oxford, OX1 3DW, UK.
Centre for Social Science Research, University of Cape Town, Cape Town, South Africa.
BMC Infect Dis. 2021 Jan 13;21(1):60. doi: 10.1186/s12879-020-05742-9.
BACKGROUND: Little evidence exists to comprehensively estimate adolescent viral suppression after initiation on antiretroviral therapy in sub-Saharan Africa. This study examines adolescent progression along the HIV care cascade to viral suppression for adolescents initiated on antiretroviral therapy in South Africa. METHODS: All adolescents ever initiated on antiretroviral therapy (n=1080) by 2015 in a health district of the Eastern Cape, South Africa, were interviewed in 2014-2015. Clinical records were extracted from 52 healthcare facilities through January 2018 (including records in multiple facilities). Mortality and loss to follow-up rates were corrected for transfers. Predictors of progression through the HIV care cascade were tested using sequential multivariable logistic regressions. Predicted probabilities for the effects of significant predictors were estimated by sex and mode of infection. RESULTS: Corrected mortality and loss to follow-up rates were 3.3 and 16.9%, respectively. Among adolescents with clinical records, 92.3% had ≥1 viral load, but only 51.1% of viral loads were from the past 12 months. Adolescents on ART for ≥2 years (AOR 3.42 [95%CI 2.14-5.47], p< 0.001) and who experienced decentralised care (AOR 1.39 [95%CI 1.06-1.83], p=0.018) were more likely to have a recent viral load. The average effect of decentralised care on recent viral load was greater for female (AOR 2.39 [95%CI 1.29-4.43], p=0.006) and sexually infected adolescents (AOR 3.48 [95%CI 1.04-11.65], p=0.043). Of the total cohort, 47.5% were recorded as fully virally suppressed at most recent test. Only 23.2% were recorded as fully virally suppressed within the past 12 months. Younger adolescents (AOR 1.39 [95%CI 1.06-1.82], p=0.017) and those on ART for ≥2 years (AOR 1.70 [95%CI 1.12-2.58], p=0.013) were more likely to be fully viral suppressed. CONCLUSIONS: Viral load recording and viral suppression rates remain low for ART-initiated adolescents in South Africa. Improved outcomes for this population require stronger engagement in care and viral load monitoring.
背景：在撒哈拉以南非洲，几乎没有证据可以全面评估青少年在开始抗逆转录病毒治疗后的病毒抑制情况。本研究考察了南非开始接受抗逆转录病毒治疗的青少年在艾滋病毒护理阶梯上的进展情况，以实现病毒抑制。
方法：2014 年至 2015 年，对南非东开普省一个卫生区所有曾于 2015 年之前接受抗逆转录病毒治疗的青少年（n=1080）进行访谈。通过 2018 年 1 月（包括多个机构的记录），从 52 家医疗机构提取临床记录。死亡率和失访率经转移校正。使用顺序多变量逻辑回归测试了 HIV 护理阶梯进展的预测因素。通过性别和感染模式估计了显著预测因素的效果预测概率。
结果：校正后的死亡率和失访率分别为 3.3%和 16.9%。在有临床记录的青少年中，92.3%有≥1 次病毒载量，但只有 51.1%的病毒载量来自过去 12 个月。接受抗逆转录病毒治疗≥2 年的青少年（AOR 3.42 [95%CI 2.14-5.47]，p<0.001）和经历过分散护理的青少年（AOR 1.39 [95%CI 1.06-1.83]，p=0.018）更有可能有最近的病毒载量。分散护理对女性（AOR 2.39 [95%CI 1.29-4.43]，p=0.006）和性感染青少年（AOR 3.48 [95%CI 1.04-11.65]，p=0.043）最近病毒载量的平均影响更大。在总队列中，47.5%的人在最近一次检测中被记录为完全病毒抑制。只有 23.2%的人在过去 12 个月内被记录为完全病毒抑制。年龄较小的青少年（AOR 1.39 [95%CI 1.06-1.82]，p=0.017）和接受抗逆转录病毒治疗≥2 年的青少年（AOR 1.70 [95%CI 1.12-2.58]，p=0.013）更有可能完全抑制病毒。
结论：在南非，开始接受抗逆转录病毒治疗的青少年的病毒载量检测和病毒抑制率仍然很低。要改善这一人群的结果，需要加强护理和病毒载量监测。
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