Kasimonje Bahati, Shamu Tinei, Mudzviti Tinashe, Luethy Ruedi
Newlands Clinic, Harare, Zimbabwe.
Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
South Afr J HIV Med. 2021 Oct 29;22(1):1292. doi: 10.4102/sajhivmed.v22i1.1292. eCollection 2021.
Sub-optimal adherence to antiretroviral therapy (ART) is reportedly worse amongst young people living with HIV (YPLHIV). Group adherence counselling can be useful to improve adherence.
We evaluated an enhanced adherence counselling group intervention (EACGI) amongst YPLHIV failing a non-nucleoside reverse transcriptase (NNRTI)-based first-line ART regimen.
This was a retrospective cohort study using routinely collected data of YPLHIV failing NNRTI-based first-line ART. Patients with confirmed virological failure were referred for EACGI, a 12-week curriculum of weekly, 1.5-h sessions accommodating 8-15 people per group. It aimed to facilitate readiness to switch to second-line ART and improve adherence through a mental health intervention. Viral loads of HIV were measured pre-EACGI; at baseline; 3, 6 and 12 months post switch.
Fifty-seven patients aged 13-25 years were invited to EACGI and followed for up to 48 weeks. Thirty-three (58%) patients attended at least four sessions, whilst 24 (42%) attended none. Amongst those who attended none, two (8%) were transferred out, three (13%) were lost to follow-up and two (8%) had died by week 48 of follow-up, whilst all who attended were still in care. By week 48, amongst patients still in care, 29%, 44% and 67% of those who attended no sessions, 4-9 and 10-12 sessions, respectively, had viral loads of < 50 copies/mL.
An EACGI is a promising intervention for YPLHIV failing ART prior to treatment switch, leading to improved adherence. This study's findings support the need for further enquiry into rigorous, evidence-based multilevel adherence interventions that are acceptable and effective for YPLHIV.
据报道，感染艾滋病毒的年轻人（YPLHIV）对抗逆转录病毒疗法（ART）的依从性欠佳情况更为严重。团体依从性咨询有助于提高依从性。
我们评估了一种强化依从性咨询团体干预措施（EACGI）对一线基于非核苷类逆转录酶抑制剂（NNRTI）的抗逆转录病毒治疗方案失败的YPLHIV患者的效果。
这是一项回顾性队列研究，使用常规收集的一线基于NNRTI的抗逆转录病毒治疗失败的YPLHIV患者的数据。确诊病毒学失败的患者被转介接受EACGI，这是一个为期12周的课程，每周进行1.5小时的课程，每组容纳8至15人。其目的是通过心理健康干预促进患者准备好转而接受二线抗逆转录病毒治疗并提高依从性。在接受EACGI之前、基线时、转换治疗后3、6和12个月测量艾滋病毒载量。
57名年龄在13至25岁之间的患者被邀请参加EACGI，并随访了长达48周。33名（58%）患者至少参加了4次课程，而24名（42%）患者一次都没参加。在那些一次都没参加的患者中，2名（8%）被转出，3名（13%）失访，2名（8%）在随访的第48周时死亡，而所有参加课程的患者仍在接受治疗。到第48周时，在仍在接受治疗的患者中，未参加任何课程、参加4 - 9次课程和参加10 - 12次课程的患者中，病毒载量<50拷贝/mL的分别占29%、44%和67%。
对于在治疗转换前抗逆转录病毒治疗失败的YPLHIV患者，EACGI是一种有前景的干预措施，可提高依从性。本研究结果支持有必要进一步探究对YPLHIV患者可接受且有效的严格、基于证据的多层次依从性干预措施。
