Institute of Tropical Medicine, Antwerp, Belgium.
Research Foundation of Flanders, Brussels, Belgium.
AIDS Res Ther. 2022 Jul 9;19(1):34. doi: 10.1186/s12981-022-00458-z.
BACKGROUND: Since the scale-up of routine viral load (VL) testing started in 2016, there is limited evidence on VL suppression rates under programmatic settings and groups at risk of non-suppression. We conducted a study to estimate VL non-suppression (> 1000 copies/ml) and its risk factors using "routine" and "repeat after enhanced adherence counselling (EAC)" VL results. METHODS: We conducted an analytic cross-sectional study using secondary VL testing data collected between 2014 and 2018 from a centrally located laboratory. We analysed data from routine tests and repeat tests after an individual received EAC. Our outcome was viral load non-suppression. Bivariable and multivariable logistic regression was performed to identify factors associated with having VL non-suppression for routine and repeat VL. RESULTS: We analysed 103,609 VL test results (101,725 routine and 1884 repeat test results) collected from the country's ten provinces. Of the 101,725 routine and 1884 repeat VL tests, 13.8% and 52.9% were non-suppressed, respectively. Only one in seven (1:7) of the non-suppressed routine VL tests had a repeat test after EAC. For routine VL tests; males (vs females, adjusted odds ratio (aOR) = 1.19, [95% CI 1.14-1.24]) and adolescents (10-19 years) (vs adults (25-49 years), aOR = 3.11, [95% CI 2.9-3.31]) were more at risk of VL non-suppression. The patients who received care at the secondary level (vs primary, aOR = 1.21, [95% CI 1.17-1.26]) and tertiary level (vs primary, aOR = 1.63, [95% CI 1.44-1.85]) had a higher risk of VL non-suppression compared to the primary level. Those that started ART in 2014-2015 (vs < 2010, aOR = 0.83, [95% CI 0.79-0.88]) and from 2016 onwards (vs < 2010, aOR = 0.84, [95% CI 0.79-0.89]) had a lower risk of VL non-suppression. For repeat VL tests; young adults (20-24 years) (vs adults (25-49 years), (aOR) = 3.48, [95% CI 2.16 -5.83]), adolescents (10-19 years) (vs adults (25-49 years), aOR = 2.76, [95% CI 2.11-3.72]) and children (0-9 years) (vs adults (25-49 years), aOR = 1.51, [95% CI 1.03-2.22]) were at risk of VL non-suppression. CONCLUSION: Close to 90% suppression in routine VL shows that Zimbabwe is on track to reach the third UNAIDS target. Strategies to improve the identification of clients with high routine VL results for repeating testing after EAC and ART adherence in subpopulations (men, adolescents and young adolescents) at risk of viral non-suppression should be prioritised.
背景：自 2016 年开始扩大常规病毒载量（VL）检测以来，关于在规划环境下和有发生病毒不抑制风险的人群中病毒载量抑制率的证据有限。我们进行了一项研究，使用“常规”和“增强依从性咨询（EAC）后重复”VL 结果来评估 VL 不抑制（>1000 拷贝/ml）及其危险因素。
方法：我们使用 2014 年至 2018 年期间从一个中心实验室收集的二次 VL 检测数据进行了分析性横断面研究。我们分析了常规检测和个体接受 EAC 后重复检测的数据。我们的结局是病毒载量不抑制。进行了两变量和多变量逻辑回归，以确定与常规和重复 VL 不抑制相关的因素。
结果：我们分析了来自该国十个省份的 103609 份 VL 检测结果（101725 份常规和 1884 份重复检测结果）。在 101725 份常规和 1884 份重复 VL 检测中，分别有 13.8%和 52.9%未被抑制。在常规 VL 检测中，只有七分之一（1：7）的未抑制检测结果在 EAC 后进行了重复检测。对于常规 VL 检测，男性（与女性相比，调整后的优势比（aOR）=1.19，[95%置信区间 1.14-1.24]）和青少年（10-19 岁）（与成年人（25-49 岁）相比，aOR=3.11，[95%置信区间 2.9-3.31]）更有可能出现 VL 不抑制。在二级（与初级相比，aOR=1.21，[95%置信区间 1.17-1.26]）和三级（与初级相比，aOR=1.63，[95%置信区间 1.44-1.85]）接受治疗的患者与初级相比，VL 不抑制的风险更高。与 2010 年之前相比，2014-2015 年（与<2010 年相比，aOR=0.83，[95%置信区间 0.79-0.88]）和 2016 年及以后（与<2010 年相比，aOR=0.84，[95%置信区间 0.79-0.89]）开始接受抗逆转录病毒治疗的患者 VL 不抑制的风险较低。对于重复 VL 检测，年轻成年人（20-24 岁）（与成年人（25-49 岁）相比，（aOR）=3.48，[95%置信区间 2.16-5.83]）、青少年（10-19 岁）（与成年人（25-49 岁）相比，aOR=2.76，[95%置信区间 2.11-3.72]）和儿童（0-9 岁）（与成年人（25-49 岁）相比，aOR=1.51，[95%置信区间 1.03-2.22]）发生 VL 不抑制的风险增加。
结论：接近 90%的常规 VL 抑制表明津巴布韦正在朝着实现第三个艾滋病规划署目标的方向前进。应优先考虑制定策略，以提高识别高常规 VL 结果的患者的能力，以便在有发生病毒不抑制风险的人群（男性、青少年和年轻青少年）中进行 EAC 后重复检测和抗逆转录病毒治疗的依从性。
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