Department of Public Health, Faculty of Medicine, University of Bunia, Bunia P.O. Box 292, Congo.
Department of Biostatistics and Epidemiology, Kinshasa School of Public Health, University of Kinshasa, Kinshasa P.O. Box 11850, Congo.
Int J Environ Res Public Health. 2022 Aug 17;19(16):10220. doi: 10.3390/ijerph191610220.
This study aims to determine the factors influencing HIV-related mortality in settings experiencing continuous armed conflict atrocities. In such settings, people living with HIV (PLHIV), and the partners of those affected may encounter specific difficulties regarding adherence to antiretroviral therapy (ART), and retention in HIV prevention, treatment, and care programs. Between July 2019 and July 2021, we conducted an observational prospective cohort study of 468 PLHIV patients treated with Dolutegravir at all the ART facilities in Bunia. The probability of death being the primary outcome, as a function of time of inclusion in the cohort, was determined using Kaplan-Meier plots. We used the log-rank test to compare survival curves and Cox proportional hazard modeling to determine mortality predictors from the baseline to 31 July 2021 (endpoint). The total number of person-months (p-m) was 3435, with a death rate of 6.70 per 1000 p-m. Compared with the 35-year-old reference group, older patients had a higher mortality risk. ART-naïve participants at the time of enrollment had a higher mortality risk than those already using ART. Patients with a high baseline viral load (≥1000 copies/mL) had a higher mortality risk compared with the reference group (adjusted hazard ratio = 6.04; 95% CI: 1.78-20.43). One-fourth of deaths in the cohort were direct victims of armed conflict, with an estimated excess death of 35.6%. Improving baseline viral load monitoring, starting ART early in individuals with high baseline viral loads, the proper tailoring of ART regimens and optimizing long-term ART, and care to manage non-AIDS-related chronic complications are recommended actions to reduce mortality. Not least, fostering women's inclusion, justice, peace, and security in conflict zones is critical in preventing premature deaths in the general population as well as among PLHIV.
本研究旨在确定在持续遭受武装冲突暴行的环境中影响与 HIV 相关的死亡率的因素。在这种环境中，HIV 感染者（PLHIV）及其受感染者的伴侣在坚持接受抗逆转录病毒疗法（ART）以及保留在艾滋病毒预防、治疗和护理方案方面可能会遇到具体困难。2019 年 7 月至 2021 年 7 月期间，我们对布尼亚所有 ART 机构中接受多替拉韦治疗的 468 名 PLHIV 患者进行了一项观察性前瞻性队列研究。使用 Kaplan-Meier 图确定死亡作为主要结局的概率，作为纳入队列的时间函数。我们使用对数秩检验比较生存曲线，使用 Cox 比例风险模型确定从基线到 2021 年 7 月 31 日（终点）的死亡率预测因子。总人数月（p-m）为 3435，死亡率为每 1000 p-m 为 6.70。与 35 岁参考组相比，年龄较大的患者死亡率更高。在登记时为 ART 初治的参与者比已经使用 ART 的参与者死亡率更高。与参考组相比，基线病毒载量较高（≥1000 拷贝/mL）的患者死亡率更高（调整后的危险比=6.04；95%CI：1.78-20.43）。队列中有四分之一的死亡是武装冲突的直接受害者，估计超额死亡人数为 35.6%。建议采取以下行动来降低死亡率：改善基线病毒载量监测，对基线病毒载量较高的个体尽早开始 ART，适当调整 ART 方案并优化长期 ART，以及管理非艾滋病相关的慢性并发症。尤其重要的是，在冲突地区促进妇女的包容、正义、和平与安全，对于预防普通人群以及 PLHIV 的过早死亡至关重要。
