Department of HIV and TB, Ministry of Health and Child Care, Harare, Zimbabwe.
Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe.
PLoS One. 2021 Jan 22;16(1):e0245720. doi: 10.1371/journal.pone.0245720. eCollection 2021.
Routine viral load (VL) testing among persons living with Human Immunodeficiency Virus (PLHIV) enables earlier detection of sub-optimal antiretroviral therapy (ART) adherence and for appropriate management of treatment failure. Since adoption of this policy by Zimbabwe in 2016, the extent of implementation is unclear. Therefore we set out to determine among PLHIV ever enrolled on ART from 2004-2017 and in ART care for ≥12 months at health facilities providing ART in Zimbabwe: numbers (proportions) with VL testing uptake, VL suppression and subsequently switched to 2nd-line ART following confirmed virologic failure.
We used retrospective data from the electronic Patient Monitoring System (ePMS) in which PLHIV on ART are registered at 525 public and 4 private health facilities.
Among the 392,832 PLHIV in ART care for ≥12 months, 99,721 (25.4%) had an initial VL test done and results available of whom 81,932 (82%) were virally suppressed. Among those with a VL>1000 copies/mL; 6,689 (37.2%) had a follow-up VL test and 4,086 (61%) had unsuppressed VLs of whom only 1,749 (42.8%) were switched to 2nd-line ART. Lower age particularly adolescents (10-19 years) were more likely (ARR 1.34; 95%CI: 1.25-1.44) to have virologic failure.
The study findings provide insights to implementation gaps including limitations in VL testing; low identification of high- risk PLHIV in care and lack of prompt utilization of test results. The use of electronic patient-level data has demonstrated its usefulness in assessing the performance of the national VL testing program. By end of 2017 implementation of VL testing was sub-optimal, and virological failure was relatively common, particularly among adolescents. Of concern is evidence of failure to act on VL test results that were received. A quality improvement initiative has been planned in response to these findings and its effect on patient management will be monitored.
对人类免疫缺陷病毒（PLHIV）感染者进行常规病毒载量（VL）检测，能够更早地发现抗逆转录病毒治疗（ART）依从性不佳的情况，并对治疗失败进行适当管理。自津巴布韦 2016 年采用这一政策以来，其实施程度尚不清楚。因此，我们着手确定在 2004 年至 2017 年间曾接受过 ART 治疗且在津巴布韦提供 ART 的 525 家公立和 4 家私立卫生机构中接受 ART 治疗≥12 个月的 PLHIV 中：VL 检测率、VL 抑制率以及随后在确诊病毒学失败后转而接受二线 ART 的人数（比例）。
我们使用电子患者监测系统（ePMS）中的回顾性数据，该系统对接受 ART 治疗的 PLHIV 进行登记，登记地点为 525 家公立和 4 家私立卫生机构。
在接受 ART 治疗≥12 个月的 392832 名 PLHIV 中，有 99721 名（25.4%）首次进行了 VL 检测，其中 81932 名（82%）病毒得到抑制。在 VL>1000 拷贝/mL 的人群中，有 6689 名（37.2%）进行了随访 VL 检测，有 4086 名（61%） VL 未得到抑制，其中只有 1749 名（42.8%）转为二线 ART。较低的年龄，尤其是青少年（10-19 岁）（ARR 1.34；95%CI：1.25-1.44）更有可能发生病毒学失败。
研究结果揭示了实施过程中的差距，包括 VL 检测的局限性、护理中高危 PLHIV 的识别率低以及未能及时利用检测结果。使用电子患者层面的数据证明了其在评估国家 VL 检测方案实施情况方面的有效性。到 2017 年底，VL 检测的实施情况并不理想，病毒学失败的情况较为常见，尤其是在青少年中。令人担忧的是，VL 检测结果的处理存在失败的证据。已计划开展一项质量改进举措来应对这些发现，将对其对患者管理的影响进行监测。
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