Institute of Public Health, Clarke International University, P.O. Box 7782, Uganda, Kampala.
Center for Human Services, University Research Co., LLC, Kampala, Uganda, P.O. Box 28745, Kampala.
BMC Public Health. 2021 Dec 18;21(1):2294. doi: 10.1186/s12889-021-12366-4.
The East Central (EC) region of Uganda has the least viral suppression rate despite having a relatively low prevalence of human immunodeficiency virus (HIV). Although the viral suppression rate in Kamuli district is higher than that observed in some of the districts in the region, the district has one of the largest populations of people living with HIV (PLHIV). We sought to examine the factors associated with viral suppression after the provision of intensive adherence counselling (IAC) among PLHIV in the district.
We reviewed records of PLHIV and used them to construct a retrospective cohort of patients that started and completed IAC during January - December 2019 at three high volume HIV treatment facilities in Kamuli district. We also conducted key informant interviews of focal persons at the study sites. We summarized the data descriptively, tested differences in the outcome (viral suppression after IAC) using chi-square and t-tests, and established independently associated factors using log-binomial regression analysis with robust standard errors at 5% statistical significance level using STATA version 15.
We reviewed 283 records of PLHIV. The mean age of the participants was 35.06 (SD 18.36) years. The majority of the participants were female (56.89%, 161/283). The viral suppression rate after IAC was 74.20% (210/283). The most frequent barriers to ART adherence reported were forgetfulness 166 (58.66%) and changes in the daily routine 130 (45.94). At multivariable analysis, participants that had a pre-IAC viral load that was greater than 2000 copies/ml [adjusted Prevalence Risk Ratio (aPRR)= 0.81 (0.70 - 0.93), p=0.002] and those that had a previous history of viral load un-suppression [aPRR= 0.79 (0.66 - 0.94), p=0.007] were less likely to achieve a suppressed viral load after IAC. ART drug shortages were rare, ART clinic working hours were convenient for clients and ART clinic staff received training in IAC.
Despite the consistency in drug availability, counselling training, flexible and frequent ART clinic days, the viral suppression rate after IAC did not meet recommended targets. A high viral load before IAC and a viral rebound were independently associated with having an unsuppressed viral load after IAC. IAC alone may not be enough to achieve viral suppression among PLHIV. To improve viral suppression rates after IAC, other complementary services should be paired with IAC.
尽管乌干达中东部地区的艾滋病毒（HIV）感染率相对较低，但病毒抑制率却是最低的。尽管卡穆利区的病毒抑制率高于该地区部分地区，但该地区是艾滋病毒感染者人数最多的地区之一。我们试图研究在该地区为艾滋病毒感染者提供强化依从不依从咨询（IAC）后，与病毒抑制相关的因素。
我们回顾了艾滋病毒感染者的记录，并使用这些记录构建了一个回顾性队列，该队列由 2019 年 1 月至 12 月期间在卡穆利区三个高容量艾滋病毒治疗设施开始并完成 IAC 的患者组成。我们还对研究地点的焦点人物进行了关键知情人访谈。我们使用 STATA 版本 15 进行了描述性汇总数据，使用卡方检验和 t 检验测试结果（IAC 后的病毒抑制）之间的差异，并使用对数二项回归分析在 5%的统计显著性水平下建立独立相关因素，采用稳健标准误差。
我们回顾了 283 名艾滋病毒感染者的记录。参与者的平均年龄为 35.06 岁（标准差 18.36 岁）。大多数参与者为女性（56.89%，161/283）。IAC 后病毒抑制率为 74.20%（210/283）。报告的最常见抗逆转录病毒治疗依从性障碍是健忘 166 例（58.66%）和日常生活变化 130 例（45.94%）。多变量分析显示，IAC 前病毒载量大于 2000 拷贝/ml 的参与者[a 比值比（aPRR）=0.81（0.70-0.93），p=0.002]和 IAC 前病毒载量未抑制的参与者[aPRR=0.79（0.66-0.94），p=0.007]更有可能在 IAC 后获得抑制的病毒载量。抗逆转录病毒药物短缺很少见，抗逆转录病毒治疗诊所的工作时间对患者方便，抗逆转录病毒治疗诊所的工作人员接受了 IAC 培训。
尽管药物供应、咨询培训、灵活频繁的抗逆转录病毒治疗诊所天数保持一致，但 IAC 后病毒抑制率仍未达到推荐目标。IAC 前高病毒载量和病毒反弹与 IAC 后未抑制的病毒载量独立相关。IAC 本身可能不足以实现艾滋病毒感染者的病毒抑制。为了提高 IAC 后的病毒抑制率，应该将其他补充服务与 IAC 结合使用。
