Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
FHI 360, Nairobi, Kenya.
PLoS One. 2022 Jul 19;17(7):e0271520. doi: 10.1371/journal.pone.0271520. eCollection 2022.
With the global push towards universal access to Antiretroviral Treatment (ART), patient numbers are increasing, further straining already under-resourced healthcare systems in sub-Saharan Africa. A simple scoring tool could be useful in optimizing differentiated service delivery by identifying individuals likely to have unsuppressed viral load.
Using existing data of patients accessing ART at public health facilities that were extracted from the Kenya Electronic Medical Record (KenyaEMR) and standard methods of developing a clinical prediction tool; we created and validated a risk scoring tool to identify persons likely to be virally unsuppressed at 18 months post-ART initiation. Data from the KenyaEMR were cleaned, merged and reviewed for completeness. We utilized multivariate modelling to determine key predictors of viral load suppression that could be measured in clinical settings.
We assessed clinical reports of 3,968 patients on ART who had been on ART for at least 18 months and had at least one viral load result and were ≥ 18 years old. Of these, the majority (81%) were virally suppressed 18 months post-ART initiation. The final risk score included age, sex, body mass index at HIV diagnosis, number of years of formal education, disclosure status, and duration of time between HIV diagnosis and initiating ART. The maximum risk score was 78; a risk score of ≥22 was associated with unsuppressed viral load (>1000copies/mL). The area under the curve (AUC) for the probability of the risk score to correctly predict unsuppressed viral load was 0.55 (95% CI: 0.52 to 0.56). Internal and external validation showed similar predictive ability.
Routinely collected variables in a public HIV clinic medical record predicts, with modest accuracy, individuals likely to have unsuppressed HIV viremia 18 months after they initiate ART. The use and application of this tool could improve and complement efficiency in differentiated care models for patients on ART.
随着全球推动普及抗逆转录病毒治疗 (ART)，患者人数不断增加，这进一步加剧了撒哈拉以南非洲资源匮乏的医疗体系的负担。一个简单的评分工具可以通过识别可能病毒载量未得到抑制的个体，从而有助于优化差异化服务提供。
我们利用从肯尼亚电子病历系统 (KenyaEMR) 中提取的、已在公立卫生机构接受 ART 的患者现有数据，并采用开发临床预测工具的标准方法，创建并验证了一个风险评分工具，以识别在开始 ART 后 18 个月时可能病毒载量未得到抑制的个体。对 KenyaEMR 中的数据进行了清理、合并和完整性审查。我们利用多变量建模来确定可在临床环境中测量的病毒载量抑制的关键预测因素。
我们评估了在开始 ART 至少 18 个月且至少有一次病毒载量结果且年龄≥18 岁的 3968 名接受 ART 的患者的临床报告。其中，大多数（81%）在开始 ART 后 18 个月时病毒载量得到抑制。最终的风险评分包括年龄、性别、HIV 诊断时的体重指数、受正规教育年限、告知状况和 HIV 诊断与开始 ART 之间的时间间隔。最高风险评分为 78；风险评分≥22 与病毒载量未得到抑制（>1000 拷贝/毫升）相关。风险评分正确预测病毒载量未得到抑制的概率的曲线下面积 (AUC) 为 0.55（95%CI：0.52 至 0.56）。内部和外部验证显示出相似的预测能力。
在公立 HIV 诊所病历中常规收集的变量可以适度准确地预测在开始 ART 后 18 个月时可能出现 HIV 病毒血症未得到抑制的个体。该工具的使用和应用可以提高和补充接受 ART 的患者差异化护理模型的效率。
