Right to Care, Centurion, South Africa.
Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
BMC Public Health. 2021 Nov 30;21(1):2194. doi: 10.1186/s12889-021-12264-9.
Patient interruption of antiretroviral therapy (ART) continues to limit HIV programs' progress toward epidemic control. Multiple factors have been associated with client interruption in treatment (IIT)- including age, gender, CD4 count, and education level. In this paper, we explore the factors associated with IIT in people living with HIV (PLHIV) in United States Agency for International Development (USAID)-supported facilities under the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) program in Nigeria.
We conducted cross-sectional analyses on data obtained from Nigeria's National Data Repository (NDR), representing a summarized record of 573 630 ART clients that received care at 484 PEPFAR/USAID-supported facilities in 16 states from 2000-2020. IIT was defined as no clinical contact for 28 days or more after the last expected clinical contact. Univariate and multivariate logistic regression models were computed to explore the factors associated with IIT. The variables included in the analysis were sex, age group, zone, facility level, regimen line, multi-month dispensing (MMD), and viral load category.
Of the 573 630 clients analysed in this study, 32% have been recorded as having interrupted treatment. Of the clients investigated, 66% were female (32% had interrupted treatment), 39% were aged 25-34 at their last ART pick-up date (with 32% of them interrupted treatment), 59% received care at secondary level facilities (37% interrupted treatment) and 38% were last receiving between three- to five-month MMD (with 10% of these interrupted treatment). Those less likely to interrupt ART were males (aOR = 0.91), clients on six-month MMD (aOR = 0.01), adults on 2 line regimen (aOR = 0.09), and paediatrics on salvage regimen (aOR = 0.02). Clients most likely to interrupt ART were located in the South West Zone (aOR = 1.99), received treatment at a tertiary level (aOR = 12.34) or secondary level facilities (aOR = 4.01), and had no viral load (VL) on record (aOR =10.02). Age group was not significantly associated with IIT.
Sex, zone, facility level, regimen line, MMD, and VL were significantly associated with IIT. MMD of three months and longer (especially six months) had better retention on ART than those on shorter MMD. Not having a VL on record was associated with a considerable risk of IIT.
患者中断抗逆转录病毒疗法（ART）继续限制艾滋病毒项目朝着控制疫情的方向取得进展。许多因素与客户中断治疗（IIT）有关，包括年龄、性别、CD4 计数和教育水平。在本文中，我们探讨了与尼日利亚美国国际开发署（USAID）支持的美国国际开发署（USAID）支持的设施中接受艾滋病毒感染者（PLHIV）中断治疗有关的因素，这些设施是在美国总统艾滋病紧急救援计划（PEPFAR）下的项目。
我们对从尼日利亚国家数据存储库（NDR）获得的数据进行了横断面分析，该数据代表了 2000 年至 2020 年间在尼日利亚 16 个州的 484 个 PEPFAR/USAID 支持的设施中接受护理的 573630 名接受抗逆转录病毒治疗的客户的汇总记录。IIT 的定义为在最后一次预期临床接触后 28 天或更长时间没有临床接触。使用单变量和多变量逻辑回归模型探讨了与 IIT 相关的因素。分析中包括的变量包括性别、年龄组、区域、设施级别、方案线、多个月配药（MMD）和病毒载量类别。
在这项研究中分析的 573630 名患者中，32%的患者记录为中断了治疗。在所调查的患者中，66%为女性（32%中断了治疗），39%在最后一次接受 ART 时年龄在 25-34 岁（其中 32%中断了治疗），59%在二级设施接受治疗（37%中断了治疗），38%最后接受三至五个月的 MMD（其中 10%中断了治疗）。不太可能中断 ART 的是男性（OR = 0.91）、接受六个月 MMD（OR = 0.01）、接受二线方案的成年人（OR = 0.09）和接受挽救方案的儿科患者（OR = 0.02）。最有可能中断 ART 的是来自西南部地区的患者（OR = 1.99）、在三级（OR = 12.34）或二级设施（OR = 4.01）接受治疗的患者，以及没有病毒载量（VL）记录的患者（OR = 10.02）。年龄组与 IIT 无显著相关性。
性别、区域、设施级别、方案线、MMD 和 VL 与 IIT 显著相关。三个月及以上的 MMD（尤其是六个月）与较短的 MMD 相比，ART 的保留率更高。没有 VL 记录与中断治疗的风险显著相关。
