Departments of Epidemiology; Medicine; Global Health, University of Washington, Seattle, WA.
Kenyatta National Hospital, Nairobi, Kenya.
J Acquir Immune Defic Syndr. 2023 Mar 1;92(3):250-259. doi: 10.1097/QAI.0000000000003131.
Tuberculosis is the leading cause of death among adolescents and young adults living with HIV (YWHIV) and their heightened risk warrants deeper understanding of utilization of tuberculosis-prevention measures within HIV care.
Retrospective study using clinic surveys and medical record data from 86 Kenyan HIV clinics.
Clinic surveys obtained information on tuberculosis preventive therapy (TPT) services. Medical records of YWHIV were abstracted. Bivariate and multivariate analyses used generalized linear models to determine individual-level and clinic-level cofactors of TPT initiation and completion.
Among 10,328 eligible YWHIV, 4337 (42.0%) initiated TPT. Of 3295 with ≥6 months follow-up, 1774 (53.8%) completed TPT. A lower patient-to-staff ratio was a clinic-level cofactor of TPT initiation ( P = 0.044) and completion ( P = 0.004); designated adolescent areas were associated with TPT initiation {prevalence ratio 2.05 [95% confidence interval (CI): 1.46 to -2.88]}. Individual cofactors of TPT initiation included younger age at HIV-care enrollment [relative risk (RR) 0.85 (95% CI: 0.80 to 0.90)] and antiretroviral therapy (ART) duration [1-2 vs. <1 year RR 1.31 (95% CI: 1.18 to 1.45)]. TPT completion was associated with younger age [RR 0.91 (95% CI: 0.85 to 0.98)] and ART duration [2-5 vs. <1 year RR 1.27 (95% CI: 1.03 to 1.57)]. In multivariate models, TPT initiation was associated with younger age and ART duration [1-2 vs. 1 year; adjusted RR 1.30 (95% CI: 1.16 to 1.46)] and TPT completion with ART duration [2-5 vs. 1 year adjusted RR 1.23 (95% CI: 0.99 to 1.52)].
Over half of YWHIV did not initiate and >40% did not complete TPT, with distinct clinic-level and individual-level cofactors. Approaches to enhance adolescent-friendly infrastructure and support older YWHIV are necessary to improve TPT use.
结核病是艾滋病毒感染者青少年和青年（YWHIV）的主要死亡原因，他们的高风险需要更深入地了解在艾滋病毒护理中利用结核病预防措施的情况。
使用来自 86 个肯尼亚艾滋病毒诊所的诊所调查和医疗记录数据进行的回顾性研究。
诊所调查获取了结核病预防治疗（TPT）服务的信息。从 YWHIV 的医疗记录中提取数据。使用广义线性模型进行单变量和多变量分析，以确定个体和诊所水平的 TPT 起始和完成的协变量。
在 10328 名符合条件的 YWHIV 中，有 4337 名（42.0%）开始接受 TPT。在 3295 名有≥6 个月随访的患者中，有 1774 名（53.8%）完成了 TPT。患者与工作人员的比例较低是 TPT 起始的诊所水平协变量（P=0.044）和完成（P=0.004）；指定的青少年区与 TPT 起始相关{优势比 2.05[95%置信区间（CI）：1.46 至-2.88]}。TPT 起始的个体协变量包括艾滋病毒护理登记时年龄较小[相对风险（RR）0.85（95%CI：0.80 至 0.90）]和抗逆转录病毒治疗（ART）持续时间[1-2 年与<1 年 RR 1.31（95%CI：1.18 至 1.45）]。TPT 完成与年龄较小相关[RR 0.91（95%CI：0.85 至 0.98）]和 ART 持续时间[2-5 年与<1 年 RR 1.27（95%CI：1.03 至 1.57）]。在多变量模型中，TPT 起始与年龄较小和 ART 持续时间相关[1-2 年与 1 年；调整后的 RR 1.30（95%CI：1.16 至 1.46）]，TPT 完成与 ART 持续时间相关[2-5 年与 1 年；调整后的 RR 1.23（95%CI：0.99 至 1.52）]。
超过一半的 YWHIV 没有开始接受 TPT，超过 40%的人没有完成 TPT，这与明显的诊所和个体水平的协变量有关。需要采取措施加强青少年友好型基础设施和支持年长的 YWHIV，以提高 TPT 的使用。
