Mwangi Anne, van Wyk Brian
School of Public Health, University of the Western Cape, Bellville, Western Cape Province, South Africa.
HIV AIDS (Auckl). 2021 Dec 24;13:1111-1118. doi: 10.2147/HIV.S345731. eCollection 2021.
Despite the success in initiating adolescents living with HIV on antiretroviral therapy (ART), questions remain about factors affecting viral suppression. In Kenya, only 63% of adolescents (aged 10-19 years) on ART had achieved viral suppression in 2016. We investigated factors associated with viral suppression among adolescents initiated on ART before November 30, 2017 in Homa Bay County, Kenya.
A retrospective cross-sectional analysis of 908 adolescents registered on ART for at least 6 months and with at least one documented viral load in the last 12 months, in six health facilities in Homa Bay County was conducted. Data were extracted from the electronic medical records and exported into an excel spreadsheet. Bivariate and multivariate logistic regression analyses were conducted to identify factors associated with viral suppression and adjust for confounding, using Stata 12.0.
Out of all participants, 80% (726) had achieved viral suppression (<1,000 copies of viral RNA/mL of blood at latest viral load count). After adjusting for other covariates, adolescents with good adherence to ART (AOR=2.3, 95% CI=1.38-3.84) and a most recent CD4 count of above 500 cells/mm (AOR=1.87, 95% CI=1.13-3.08), were more likely to be virally suppressed. Adolescents on second line ART treatment (AOR=0.45, 95% CI=0.28-0.73) and having inadequate adherence to ART (AOR=0.26, 95% CI=0.11-63) were less likely to be virally suppressed.
Viral suppression for adolescents on ART in this study is significantly higher than the national prevalence in 2016 (80% vs 63%), but it is still below the WHO target of 90%. Enhanced adherence support for adolescents on ART should be implemented to improve long-term adherence. Specific interventions are needed to "rescue" adolescents on second-line ART regimens who may have a history of poor adherence.
尽管在让感染艾滋病毒的青少年开始接受抗逆转录病毒治疗（ART）方面取得了成功，但关于影响病毒抑制的因素仍存在疑问。在肯尼亚，2016年接受抗逆转录病毒治疗的青少年（10至19岁）中只有63%实现了病毒抑制。我们调查了2017年11月30日前在肯尼亚霍马湾县开始接受抗逆转录病毒治疗的青少年中与病毒抑制相关的因素。
对霍马湾县六家医疗机构中908名登记接受抗逆转录病毒治疗至少6个月且在过去12个月内至少有一次记录的病毒载量的青少年进行回顾性横断面分析。数据从电子病历中提取并导出到Excel电子表格中。使用Stata 12.0进行双变量和多变量逻辑回归分析，以确定与病毒抑制相关的因素并调整混杂因素。
在所有参与者中，80%（726名）实现了病毒抑制（最新病毒载量计数时每毫升血液中病毒RNA低于1000拷贝）。在调整其他协变量后，对抗逆转录病毒治疗依从性良好的青少年（调整后比值比[AOR]=2.3，95%置信区间[CI]=1.38 - 3.84）以及最近CD4计数高于500个细胞/mm³的青少年（AOR=1.87，95% CI=1.13 - 3.08）更有可能实现病毒抑制。接受二线抗逆转录病毒治疗的青少年（AOR=0.45，95% CI=0.28 - 0.73）以及对抗逆转录病毒治疗依从性不足的青少年（AOR=0.26，95% CI=0.11 - 0.63）实现病毒抑制的可能性较小。
本研究中接受抗逆转录病毒治疗的青少年的病毒抑制率显著高于2016年的全国患病率（80%对63%），但仍低于世界卫生组织90% 的目标。应加强对接受抗逆转录病毒治疗青少年的依从性支持，以提高长期依从性。需要采取具体干预措施来“挽救”可能有依从性差病史的接受二线抗逆转录病毒治疗方案 的青少年。
