Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration Kampala, Kampala, Uganda.
RineCynth Advisory Limited, Kampala, Uganda.
AIDS Res Ther. 2023 Mar 30;20(1):18. doi: 10.1186/s12981-023-00513-3.
BACKGROUND: The Joint United Nations Programme on HIV/AIDS through the 95-95-95 target requires 95% of people living with HIV (PLHIV) on antiretroviral treatment (ART) to be virally suppressed. Viral Load (VL) non-suppression has been found to be associated with suboptimal ART adherence, and Intensive Adherence Counselling (IAC) has been shown to lead to VL re-suppression by over 70% in PLHIV on ART. Currently, there is data paucity on VL suppression after IAC in adult PLHIV in Uganda. This study aimed to evaluate the proportion of VL suppression after IAC and associated factors among adult PLHIV on ART at Kiswa Health Centre in Kampala, Uganda. METHODS: Study was a retrospective cohort design and employed secondary data analysis to review routine program data. Medical records of adult PLHIV on ART for at least six months with VL non-suppression from January 2018 to June 2020 at Kiswa HIV clinic were examined in May 2021. Descriptive statistics were applied to determine sample characteristics and study outcome proportions. Multivariable modified Poisson regression analysis was employed to assess predictors of VL suppression after IAC. RESULTS: Analysis included 323 study participants of whom 204 (63.2%) were female, 137 (42.4%) were between the age of 30 and 39 years; and median age was 35 years (interquartile range [IQR] 29-42). Participant linkage to IAC was 100%. Participants who received the first IAC session within 30 days or less after unsuppressed VL result were 48.6% (157/323). Participants who received recommended three or more IAC sessions and achieved VL suppression were 66.4% (202/304). The percentage of participants who completed three IAC sessions in recommended 12 weeks was 34%. Receipt of three IAC sessions (ARR = 1.33, 95%CI: 1.15-1.53, p < 0.001), having baseline VL of 1,000-4,999 copies/ml (ARR = 1.47, 95%CI: 1.25-1.73, p < 0.001) and taking Dolutegravir containing ART regimen were factors significantly associated with VL suppression after IAC. CONCLUSION: VL suppression proportion of 66.4% after IAC in this population was comparable to 70%, the percentage over which adherence interventions have been shown to cause VL re-suppression. However, timely IAC intervention is needed from receipt of unsuppressed VL results to IAC process completion.
背景：联合国艾滋病规划署通过 95-95-95 目标要求 95%接受抗逆转录病毒治疗（ART）的艾滋病毒感染者（PLHIV）病毒得到抑制。已经发现病毒载量（VL）未抑制与 ART 依从性不足有关，强化依从性咨询（IAC）已被证明可使接受 ART 的 PLHIV 的 VL 再抑制率超过 70%。目前，乌干达成人 PLHIV 在接受 IAC 后的 VL 抑制数据不足。本研究旨在评估 Kiswa 保健中心接受 IAC 的成人 PLHIV 的 VL 抑制比例以及接受 ART 的成人 PLHIV 的相关因素。
方法：这是一项回顾性队列设计研究，采用二次数据分析方法审查常规项目数据。2021 年 5 月，对 Kiswa HIV 诊所 2018 年 1 月至 2020 年 6 月期间至少接受了六个月 ART 治疗且 VL 未得到抑制的成人 PLHIV 的医疗记录进行了检查。应用描述性统计方法确定样本特征和研究结果的比例。采用多变量修正泊松回归分析评估 IAC 后 VL 抑制的预测因素。
结果：分析纳入了 323 名研究参与者，其中 204 名（63.2%）为女性，137 名（42.4%）年龄在 30 至 39 岁之间；中位年龄为 35 岁（四分位距 [IQR] 29-42）。参与者与 IAC 的联系率为 100%。在 VL 结果未得到抑制后 30 天或更短时间内接受首次 IAC 治疗的参与者占 48.6%（157/323）。接受推荐的三次或更多次 IAC 治疗并实现 VL 抑制的参与者占 66.4%（202/304）。在 12 周内完成三次 IAC 治疗的参与者比例为 34%。接受三次 IAC 治疗（ARR=1.33，95%CI：1.15-1.53，p<0.001）、基线 VL 为 1000-4999 拷贝/ml（ARR=1.47，95%CI：1.25-1.73，p<0.001）和接受含有多替拉韦的 ART 方案是 IAC 后 VL 抑制的显著相关因素。
结论：该人群 IAC 后 VL 抑制率为 66.4%，与依从性干预措施已被证明可使 VL 再抑制率提高 70%的比例相当。然而，需要从未抑制的 VL 结果开始及时进行 IAC 干预，直至完成 IAC 过程。
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