Department of Public Health, Faculty of Health Sciences and Nursing, Bishop Stuart University, Mbarara, Uganda.
Department of Ethnobotany, Bishop Stuart University, Mbarara, Uganda.
PLoS One. 2022 Aug 18;17(8):e0270855. doi: 10.1371/journal.pone.0270855. eCollection 2022.
The goal of antiretroviral therapy is to achieve sustained human immune deficiency virus (HIV) viral suppression. However, research on factors associated with viral load suppression among adolescents in low and middle-income countries is limited. The objectives of this study were to determine HIV viral suppression levels among adolescents in Kabale district and the associated clinical, adherence and psychosocial factors.
Cross-sectional and retrospective cohort study designs were used. Two hundred and forty-nine adolescents living with HIV that attended clinics between September and October 2019 at nine health facilities were interviewed and their medical records reviewed. A data abstraction tool was used to collect clinical data from adolescent's clinical charts, face to face interviews were conducted using semi-structured questionnaire adopted from the HEADS tool and in-depth interviews conducted with ten key informants. Qualitative data was analyzed using thematic content analysis. Logistic regression was used to determine the magnitude by which clinical and psychosocial factors influence viral load suppression. Odds Ratios (ORs) were used for statistical associations at 95% confidence interval considering statistical significance for p-values less than 0.05. Qualitative data collected from Key informants to support our quantitative findings was analyzed using thematic content analysis.
HIV viral suppression among (n = 249) adolescents was at 81%. Having no severe opportunistic infections was associated with viral load suppression among adolescent living with HIV (OR = 1.09; 95%CI [1.753-4.589]; p<0.001) as well as having no treatment interruptions (OR = 0.86; 95% CI [2.414-6.790]; p = 0.004). Belonging to a support group (OR = 1.01; 95% CI [1.53-4.88]; P = 0.020), having parents alive (OR = 2.04; 95% CI[1.02-4.12]; P = 0.047) and having meals in a day (OR = 5.68; C.I = 2.38-6.12, P = 0.010), were significantly associated to viral load suppression. The findings also indicated that long distances from health facilities, transport challenges and unprofessional conduct of health workers that make adolescent unwelcome at health facilities negatively affected viral suppression among adolescents.
The findings indicate that HIV viral suppression among adolescents on ART was at 81%. Kabale district was likely not to achieve the third 90 of the UNAIDS 90-90-90 global target for this population category. The findings further indicate that having no severe opportunistic infection and no treatment interruptions, good nutrition status, peer support and support from significant others, were highly associated with viral load suppression.
抗逆转录病毒疗法的目标是实现持续的人类免疫缺陷病毒（HIV）病毒抑制。然而，针对中低收入国家青少年与病毒载量抑制相关的研究有限。本研究的目的是确定卡巴莱区青少年的 HIV 病毒抑制水平以及相关的临床、依从性和心理社会因素。
采用横断面和回顾性队列研究设计。对 2019 年 9 月至 10 月期间在 9 个卫生机构就诊的 249 名青少年进行访谈，并查阅其病历。使用数据提取工具从青少年的临床图表中收集临床数据，使用从 HEADS 工具采用的半结构式问卷进行面对面访谈，并对 10 名关键知情人进行深入访谈。使用主题内容分析法对定性数据进行分析。使用逻辑回归确定临床和心理社会因素对病毒载量抑制的影响程度。考虑到 p 值<0.05 的统计学意义，使用优势比（ORs）表示 95%置信区间的统计学关联。使用主题内容分析法对关键知情人收集的支持我们定量发现的定性数据进行分析。
（n=249）青少年的 HIV 病毒抑制率为 81%。无严重机会性感染与 HIV 感染者的病毒载量抑制有关（OR=1.09；95%CI [1.753-4.589]；p<0.001），无治疗中断也与病毒载量抑制有关（OR=0.86；95%CI [2.414-6.790]；p=0.004）。参加支持小组（OR=1.01；95%CI [1.53-4.88]；P=0.020）、父母健在（OR=2.04；95%CI[1.02-4.12]；P=0.047）和每天进餐（OR=5.68；CI=2.38-6.12，P=0.010）与病毒载量抑制显著相关。研究结果还表明，距离卫生机构较远、交通挑战以及卫生工作者的不专业行为使青少年在卫生机构不受欢迎，这对青少年的病毒抑制产生了负面影响。
研究结果表明，青少年接受抗逆转录病毒治疗后的 HIV 病毒抑制率为 81%。卡巴莱区可能无法实现联合国艾滋病规划署 90-90-90 全球目标中针对这一人群的第三个 90 目标。研究结果还表明，无严重机会性感染和治疗中断、良好的营养状况、同伴支持和重要他人的支持与病毒载量抑制高度相关。
