Africa Health Research Institute, Somkhele campus, R618 en Route To Hlabisa, Mtubatuba, 3935, KwaZulu-Natal, South Africa.
School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
AIDS Behav. 2021 Nov;25(11):3695-3703. doi: 10.1007/s10461-021-03319-4. Epub 2021 Jun 7.
Accurate reporting of antiretroviral therapy (ART) uptake is crucial for measuring the success of epidemic control. Programs without linked electronic medical records are susceptible to duplicating ART initiation events. We assessed the prevalence of undisclosed ART use at the time of treatment initiation and explored its correlates among people presenting to public ambulatory clinics in South Africa. Data were analyzed from the community-based delivery of ART (DO ART) clinical trial, which recruited people living with HIV who presented for ART initiation at two clinics in rural South Africa. We collected data on socioeconomic factors, clinical factors, and collected blood as part of study screening procedures. We estimated the proportion of individuals presenting for ART initiation with viral load suppression (< 20 copies/mL) and fitted regression models to identify social and clinical correlates of non-disclosure of ART use. We also explored clinical and national databases to identify records of ART use. Finally, to confirm surreptitious ART use, we measured tenofovir (TDF) and emtricitabine (FTC) levels in dried blood spots. A total of 193 people were screened at the two clinics. Approximately 60% (n = 114) were female, 40% (n = 78) reported a prior HIV test, 23% (n = 44) had disclosed to a partner, and 31% (n = 61) had a partner with HIV. We found that 32% (n = 62) of individuals presenting for ART initiation or re-initiation had an undetectable viral load. In multivariable regression models, female sex (AOR 2.16, 95% CI 1.08-4.30), having a prior HIV test and having disclosed their HIV status (AOR 2.48, 95% CI 1.13-5.46), and having a partner with HIV (AOR 1.94, 95% CI 0.95-3.96) were associated with having an undetectable viral load. In records we reviewed, we found evidence of ART use from either clinical or laboratory databases in 68% (42/62) and detected either TDF or FTC in 60% (37/62) of individuals with an undetectable viral load. Undisclosed ART use was present in approximately one in three individuals presenting for ART initiation or re-initiation at ambulatory HIV clinics in South Africa. These results have important implications for ART resource use and planning in the region. A better understanding of reasons for non-disclosure of ART at primary health care clinics in such settings is needed.
准确报告抗逆转录病毒疗法 (ART) 的使用情况对于衡量疫情控制的成功至关重要。没有关联电子病历的项目容易重复记录 ART 起始事件。我们评估了在治疗开始时未公开使用 ART 的流行率，并在南非的两家门诊诊所就诊的人群中探讨了其相关因素。本研究数据来自基于社区的抗逆转录病毒治疗（DO ART）临床试验，该试验招募了在南非农村的两家诊所就诊的 HIV 感染者，以进行抗逆转录病毒治疗的起始。我们收集了社会经济因素、临床因素的数据，并采集了血液作为研究筛选程序的一部分。我们估计了就诊开始进行抗逆转录病毒治疗时病毒载量抑制（<20 拷贝/ml）的个体比例，并拟合回归模型以确定未披露 ART 使用的社会和临床相关性。我们还探索了临床和国家数据库，以确定抗逆转录病毒治疗使用的记录。最后，为了确认秘密使用抗逆转录病毒治疗，我们测量了干血斑中的替诺福韦（TDF）和恩曲他滨（FTC）水平。共有 193 人在两家诊所接受了筛查。大约 60%（n=114）为女性，40%（n=78）报告之前接受过 HIV 检测，23%（n=44）已向伴侣披露，31%（n=61）的伴侣患有 HIV。我们发现，就诊开始或重新开始接受抗逆转录病毒治疗的个体中有 32%（n=62）的病毒载量无法检测到。在多变量回归模型中，女性（OR 2.16，95%CI 1.08-4.30）、之前接受过 HIV 检测和披露 HIV 状况（OR 2.48，95%CI 1.13-5.46）以及伴侣患有 HIV（OR 1.94，95%CI 0.95-3.96）与病毒载量无法检测到相关。在我们审查的记录中，我们在临床或实验室数据库中发现了 68%（42/62）的抗逆转录病毒治疗使用证据，并在 60%（37/62）的病毒载量无法检测到的个体中检测到 TDF 或 FTC。在南非门诊艾滋病毒诊所就诊开始或重新开始抗逆转录病毒治疗的个体中，大约有三分之一的人未公开使用抗逆转录病毒治疗。这些结果对抗逆转录病毒资源在该地区的使用和规划具有重要意义。需要更好地了解在这种情况下初级保健诊所未披露抗逆转录病毒治疗的原因。
