Kose Judith, Tiam Appolinaire, Siamba Stephen, Lenz Cosima, Okoth Elizabeth, Wolters Theresa, van de Vijver David, Rakhmanina Natella
Elizabeth Glaser Pediatric AIDS Foundation, Nairobi, Kenya.
Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States of America.
PLOS Glob Public Health. 2022 Feb 22;2(2):e0000094. doi: 10.1371/journal.pgph.0000094. eCollection 2022.
In Kenya, HIV/AIDS remains a leading cause of morbidity and mortality among adolescents living with HIV (ALHIV). Our study evaluated associations between demographic and healthcare factors and HIV treatment outcomes among ALHIV in care in Kenya. This retrospective cohort study evaluated the clinical outcomes of newly diagnosed ALHIV enrolled in HIV care during January 2017-June 2018 at 32 healthcare facilities in Homabay and Kakamega Counties. Demographic and clinical data were abstracted from patient clinical records and registers during the follow up study period January 2017-through May 2019. ALHIV were stratified by age (10-14 versus 15-19 years). Categorical variables were summarized using descriptive statistics; continuous variables were analyzed using mean values. The latest available treatment and virological outcomes for ALHIV were assessed. 330 ALHIV were included in the study (mean age 15.9 years; 81.8% female, 63.0% receiving HIV care at lower-level healthcare facilities). Most (93.2%) were initiated on ART within 14 days of diagnosis; 91.4% initiated EFV-based regimens. Of those on ART, only 44.6% were active on care at the end of the study period. Of those eligible for viral load testing, 83.9% were tested with 84.4% viral suppression rate. Retention in care was higher at higher-level facilities (67.5%) compared to lower-level facilities (28.6%). Factors associated with higher retention in care were school attendance (aRR = 1.453), receipt of disclosure support (aRR = 13.315), and receiving care at a high-level health facility (aRR = 0.751). Factors associated with viral suppression included older age (15-19 years) (aRR = 1.249) and pre-ART clinical WHO stage I/II (RR = .668). Viral suppression was higher among older ALHIV. Studies are needed to evaluate effective interventions to improve outcomes among ALHIV in Kenya.
在肯尼亚，艾滋病毒/艾滋病仍然是感染艾滋病毒的青少年（ALHIV）发病和死亡的主要原因。我们的研究评估了肯尼亚接受治疗的ALHIV的人口统计学和医疗保健因素与艾滋病毒治疗结果之间的关联。这项回顾性队列研究评估了2017年1月至2018年6月期间在霍马湾和卡卡梅加县32家医疗保健机构新诊断接受艾滋病毒治疗的ALHIV的临床结果。在2017年1月至2019年5月的随访研究期间，从患者临床记录和登记册中提取了人口统计学和临床数据。ALHIV按年龄分层（10 - 14岁与15 - 19岁）。分类变量使用描述性统计进行汇总；连续变量使用平均值进行分析。评估了ALHIV最新可用的治疗和病毒学结果。330名ALHIV纳入研究（平均年龄15.9岁；81.8%为女性，63.0%在基层医疗保健机构接受艾滋病毒治疗）。大多数（93.2%）在诊断后14天内开始接受抗逆转录病毒治疗（ART）；91.4%开始使用基于依非韦伦的治疗方案。在接受ART治疗的患者中，研究期末只有44.6%仍在接受积极治疗。在 eligible for viral load testing的患者中，83.9%接受了检测，病毒抑制率为84.4%。与基层医疗保健机构（28.6%）相比，高级别机构的治疗保留率更高（67.5%）。与更高治疗保留率相关的因素包括上学（调整后风险比[aRR]=1.453）、获得披露支持（aRR = 13.315）以及在高级别医疗机构接受治疗（aRR = 0.751）。与病毒抑制相关的因素包括年龄较大（15 - 19岁）（aRR = 1.249）和ART前临床世界卫生组织I/II期（风险比[RR]=0.668）。年龄较大的ALHIV病毒抑制率更高。需要开展研究以评估有效干预措施，改善肯尼亚ALHIV的治疗结果。 （注：原文中“eligible for viral load testing”可能表述有误，推测为“符合病毒载量检测条件的”，翻译时保留原文表述）
