Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration Kampala, Kampala, Uganda.
Department of Public Health and Preventive Medicine, School of Medicine, University of Liverpool, Liverpool, UK.
AIDS Res Ther. 2021 Dec 4;18(1):91. doi: 10.1186/s12981-021-00408-1.
Adolescents are lagging behind in the "third 95" objective of the Joint United Nations Program on HIV/AIDS requiring 95% of individuals on antiretroviral therapy (ART) to have viral load (VL) suppression. This study aimed to describe factors associated with viral non-suppression among adolescents in Mbale district, Uganda.
We conducted a retrospective review of routinely collected HIV programme records. Data such as age, education, ART Regimen, ART duration, WHO Clinical stage, comorbidities, etc., were extracted from medical records for the period January 2018 to December 2018. Descriptive analysis was done for continuous variables using means and frequencies to describe study sample characteristics, and to determine the prevalence of outcome variables. We used logistic regression to assess factors associated with VL non-suppression among adolescents.
The analysis included 567 HIV-infected adolescents, with 300 (52.9%) aged between 13 to 15 years, 335 (59.1%) female, and mean age of 15.6 years (interquartile range [IQR] 13.5-17.8. VL non-suppression was 31.4% (178/567). Male sex (AOR = 1.78, 95% CI 1.06, 2.99; p < 0.01), age 16-19 years (AOR = 1.78, 95% CI 1.06, 2.99; p < 0.05), No formal education (AOR = 3.67, 95% CI 1.48-9.09; p < 0.01), primary education (AOR = 2.23, 95% CI 1.05-2.32; p < 0.01), ART duration of > 12 months to 5 years (AOR = 3.20, 95% CI 1.31-7.82; p < 0.05), ART duration > 5 years (AOR = 3.47, 95% CI 1.39- 8.66; p < 0.01), WHO Clinical Stage II (AOR = 0.48, 95% CI: 0.28, 0.82; p < 0.01), second-line ART regimen (AOR = 2.38, 95% CI 1.53-3.72; p < 0.001) and comorbidities (AOR = 3.28, 95% CI 1.20-9.00; p < 0.05) were significantly associated with viral non-suppression.
VL non-suppression among adolescents was almost comparable to the national average. VL non-suppression was associated with being male, age 16-19 years, education level, duration on ART therapy, WHO Clinical Staging II, second-line ART regimen, and presence of comorbidities. Adolescent-friendly strategies to improve VL suppression e.g. peer involvement, VL focal persons to identify and actively follow-up non-suppressed adolescents, patient education on VL suppression and demand creation for ART are needed, especially for newly-initiated adolescents and adolescents on ART for protracted periods, to foster attainment of the UNAIDS 95-95-95 targets.
青少年在联合国艾滋病规划署联合方案的“第三个 95”目标方面滞后，该目标要求 95%接受抗逆转录病毒疗法（ART）的个体病毒载量（VL）得到抑制。本研究旨在描述乌干达姆巴莱区青少年病毒不抑制的相关因素。
我们对常规收集的 HIV 项目记录进行了回顾性审查。从病历中提取了年龄、教育程度、ART 方案、ART 持续时间、世界卫生组织临床分期、合并症等数据，时间范围为 2018 年 1 月至 2018 年 12 月。使用均值和频率对连续变量进行描述性分析，以描述研究样本特征，并确定结局变量的患病率。我们使用逻辑回归来评估与青少年病毒不抑制相关的因素。
分析纳入了 567 名感染 HIV 的青少年，其中 300 名（52.9%）年龄在 13 至 15 岁之间，335 名（59.1%）为女性，平均年龄为 15.6 岁（IQR 为 13.5-17.8。VL 不抑制率为 31.4%（178/567）。男性（优势比[OR] = 1.78，95%置信区间[CI]为 1.06-2.99；p<0.01）、年龄 16-19 岁（OR = 1.78，95%CI 为 1.06-2.99；p<0.05）、无正规教育（OR = 3.67，95%CI 为 1.48-9.09；p<0.01）、小学教育（OR = 2.23，95%CI 为 1.05-2.32；p<0.01）、ART 持续时间>12 个月至 5 年（OR = 3.20，95%CI 为 1.31-7.82；p<0.05）、ART 持续时间>5 年（OR = 3.47，95%CI 为 1.39-8.66；p<0.01）、世界卫生组织临床分期 II 期（OR = 0.48，95%CI：0.28，0.82；p<0.01）、二线 ART 方案（OR = 2.38，95%CI 为 1.53-3.72；p<0.001）和合并症（OR = 3.28，95%CI 为 1.20-9.00；p<0.05）与病毒不抑制显著相关。
青少年的 VL 不抑制率与全国平均水平相当。VL 不抑制与男性、年龄 16-19 岁、教育程度、ART 治疗持续时间、世界卫生组织临床分期 II 期、二线 ART 方案和合并症有关。需要采取青少年友好型策略来提高 VL 抑制率，例如同伴参与、指定 VL 监测人员以主动发现和积极随访未抑制的青少年、对 VL 抑制进行患者教育以及对 ART 的需求创造，特别是对于新开始接受 ART 的青少年和接受 ART 治疗时间较长的青少年，以促进实现联合国艾滋病规划署的 95-95-95 目标。
