Amref Health Africa, Ali Hassan Mwinyi Road Plot 1019 P O, Box 2773, Dar es Salaam, Tanzania.
Department of General Studies, Dar es Salaam Institute of Technology, P O Box 2958, Dar es Salaam, Tanzania.
AIDS Res Ther. 2023 Mar 30;20(1):19. doi: 10.1186/s12981-023-00512-4.
BACKGROUND: Interruption in Treatment (IIT) is a challenge in HIV care and treatment programs in sub- Saharan Africa. High IIT among HIV adolescents has both individual and potential public health consequences including discontinuation of treatment, increased HIV transmission and risk of death. In this era of test and treat policy it is important to ensure that patients remain connected to HIV clinics to enable achieve UNAIDS 95-95-95 targets timely. This study aimed to assess risk factors for IIT among HIV-positive adolescence in Tanzania. METHODS: We conducted retrospective longitudinal cohort study using secondary data of adolescent patients enrolled in care and treatment clinics in Tanga from October 2018 to December 2020. We defined Interuption in Treatment as missing clinic visits for 90 consecutive days after the last scheduled appointment date on anti-retroviral therapy (ART). Cox proportional hazard regression models were employed to identify risk factors of the outcome variable. RESULTS: Among 2,084 adolescents of age between 15 and 19 years were followed for two years, whereby 546 (26.2%) had interrupted treatment. The median age of the participants was 14.6 years (interquartile range, IQR: 12.6-16.6 years), with age between 15 and 19 years, male sex, with advanced HIV disease and were not on Dolutegravir (DTG) related regimens were associated with interruption in treatment; (Hazard ratio (HR) 1.43, 95% CI: 1.23-1.66, p < 0.0001, HR 2.47, 95% CI: 1.62-3.77, p < 0.0001, HR: 2.47, 95% CI: 1.91- 3.21, p < 0.0001 and HR: 6.67, 95% CI: 3.36- 7.04, p < 0.0001 respectively). Adolescents who were on ART for less or equal one year compared to those on ART for more than one year were protective toward interruption in treatment (HR: 0.68, 95% CI: 0.54-0.87, p = 0.002). CONCLUSIONS: The risk of interruption in treatment was high among adolescents in HIV care and treatment facilities in Tanga. This might lead to poor clinical outcomes, and increased drug resistance among ART-initiated adolescents. Placing more adolescents with DTG based drug, strengthening access to care and treatment and rapid tracking of patients is recommended to improve patient outcomes.
背景：中断治疗（IIT）是撒哈拉以南非洲国家艾滋病护理和治疗项目面临的挑战。艾滋病毒青少年中较高的 IIT 率既有个人影响，也有潜在的公共卫生影响，包括停止治疗、增加艾滋病毒传播和死亡风险。在目前的检测和治疗政策时代，确保患者与艾滋病毒诊所保持联系，以实现联合国艾滋病规划署 95-95-95 目标，这一点非常重要。本研究旨在评估坦桑尼亚艾滋病毒阳性青少年中断治疗的危险因素。
方法：我们对 2018 年 10 月至 2020 年 12 月在坦噶护理和治疗诊所登记的青少年患者进行了回顾性纵向队列研究。我们将中断治疗定义为在最后一次抗逆转录病毒治疗（ART）预约日期后 90 天内连续错过门诊就诊。采用 Cox 比例风险回归模型确定结局变量的危险因素。
结果：在随访两年的 2084 名年龄在 15 至 19 岁之间的青少年中，有 546 名（26.2%）中断了治疗。参与者的中位年龄为 14.6 岁（四分位距，IQR：12.6-16.6 岁），年龄在 15 至 19 岁之间、男性、HIV 疾病晚期且未接受多替拉韦（DTG）相关方案的患者，与中断治疗有关；（风险比（HR）1.43，95%CI：1.23-1.66，p<0.0001，HR 2.47，95%CI：1.62-3.77，p<0.0001，HR：2.47，95%CI：1.91-3.21，p<0.0001，HR：6.67，95%CI：3.36-7.04，p<0.0001）。与 ART 治疗 1 年以上的青少年相比，ART 治疗时间少于或等于 1 年的青少年中断治疗的风险较低（HR：0.68，95%CI：0.54-0.87，p=0.002）。
结论：坦噶的艾滋病毒护理和治疗设施中，青少年中断治疗的风险很高。这可能导致临床结局不佳，并增加开始接受抗逆转录病毒治疗的青少年的耐药性。建议为更多的青少年提供基于 DTG 的药物、加强获得护理和治疗的机会以及快速跟踪患者，以改善患者的治疗结果。
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