Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia.
Department of Internal Medicine, School of Medicine, University of Zambia, Lusaka, Zambia.
Front Public Health. 2023 Mar 13;11:1094214. doi: 10.3389/fpubh.2023.1094214. eCollection 2023.
Coronavirus disease 2019 (COVID-19)-related disruptions in healthcare services and clinical outcomes have been predicted and documented. However, little is known about how antiretroviral therapy (ART) adherence disruptions caused by the COVID-19 pandemic have manifested amidst the 'Undetectable = Untransmittable' campaign initiative. Using a patient's viral load as a proxy for medication adherence, our study aimed to determine the adherence to ART on first-line medications among adult people living with human immunodeficiency virus (PLWHIV) at the University Teaching Hospital in Lusaka, Zambia during the pandemic.
This was a hospital-based cross-sectional study. Secondary data of PLWHIV registered to receive ART from the Adult Infectious Disease Centre was extracted from the SmartCare electronic health record system to constitute a resultant data set that this study used. The data extraction form was used to extract values of dependent (ART adherence measured by viral load detectability) and independent variables and imported them into the statistical analysis tool, STATA version 16.1 MP. Descriptive statistics of individual characteristics, testing for associations using Pearson's chi-square test, and stratified and combined multivariable logistic regression were performed.
Of the 7,281 adult PLWHIV included in this study, 9.0% (95% CI 8.3-9.6%) were virally detectable. Estimates of the odds ratios of detectable viral load remained significantly higher among adult PLWHIV who were initiated on ART after the U=U campaign was launched in Zambia and were on a monthly 2.51 (1.31-9.03) or 6-monthly 4.75 (3.52-6.41) dispensing of a dolutegravir-based regimen and those on 6-monthly dispensing of an efavirenz-based regimen 4.67 (2.16-10.08) compared to their counterparts. Overall estimates showed us the same picture 4.14 (3.22-5.31), having adjusted for all other predictor variables.
We found that a high proportion of people with detectable viral load in the study population, irrespective of medication refill interval and type of regimen, was concentrated among adult PLWHIV who started treatment during the COVID-19 epidemic waves, as compared to those who started treatment before the pandemic. This observed disparity suggests the inherent impact of the pandemic on the adherence to ART among adult PLWHIV in Lusaka, Zambia. This further illustrates how exposed program responses are to external shocks, especially in already weakened health systems, and the need to create program response buffers and resilient program-specific strategies to minimize the effect of external disruptions.
人们曾预测并记录了与 2019 年冠状病毒病（COVID-19）相关的医疗服务和临床结果的中断。然而，人们对于在“检测不到=不传播”活动倡议下，COVID-19 大流行如何导致抗逆转录病毒疗法（ART）的依从性中断知之甚少。本研究使用患者的病毒载量作为药物依从性的替代指标，旨在确定赞比亚卢萨卡大学教学医院的成人艾滋病毒感染者（PLWHIV）在大流行期间首次使用一线药物进行 ART 的依从性。
这是一项基于医院的横断面研究。从 SmartCare 电子健康记录系统中提取在成人传染病中心登记接受 ART 的 PLWHIV 的二级数据，构成本研究使用的原始数据集。使用数据提取表提取依赖变量（通过病毒载量检测性测量的 ART 依从性）和独立变量的值，并将其导入统计分析工具 STATA 版本 16.1 MP。对个体特征进行描述性统计，使用 Pearson's chi-square 检验进行关联性检验，并进行分层和综合多变量逻辑回归。
在这项研究中，纳入了 7281 名成人 PLWHIV，其中 9.0%（95%CI8.3-9.6%）可检测到病毒。在赞比亚启动“U=U”运动后开始接受 ART 的成人 PLWHIV 和每月 2.51（1.31-9.03）或每 6 个月 4.75（3.52-6.41）服用基于度鲁特韦的方案以及每 6 个月服用基于依非韦伦的方案的成人 PLWHIV，其检测到病毒载量的比值比仍然显著更高，与对照组相比，4.67（2.16-10.08）和 4.14（3.22-5.31）。总体估计结果表明，在调整了所有其他预测变量后，我们得到了相同的结果。
我们发现，研究人群中相当大比例的病毒载量可检测者，无论药物补充间隔和方案类型如何，都集中在 COVID-19 流行期间开始治疗的成年 PLWHIV 中，而不是在大流行前开始治疗的患者中。这种观察到的差异表明，大流行对赞比亚卢萨卡的成年 PLWHIV 的 ART 依从性产生了内在影响。这进一步说明了方案应对措施对外界冲击的暴露程度，尤其是在已经脆弱的卫生系统中，以及需要建立方案应对缓冲区和有弹性的特定方案策略，以尽量减少外部干扰的影响。
