Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
Research Department, Infectious Diseases Institute, Makerere University, Kampala, Uganda.
PLoS One. 2023 Oct 19;18(10):e0293057. doi: 10.1371/journal.pone.0293057. eCollection 2023.
Virological non-suppression is a critical factor in driving HIV transmission rates, yet there is limited data available on the determinants of this phenomenon, particularly in fishing communities where the incidence of HIV is disproportionately high. We aimed to determine the prevalence and determinants of virological non-suppression among adult males (≥15 years) attending HIV care services in the fishing communities of Bulisa district.
We conducted a cross-sectional study among all adult males (≥15 years) living with HIV who were resident within the fishing communities, and in care for atleast 6 months at the six health facilities offering HIV services in the fishing communities in Bulisa district. To obtain data on patient and health facility characteristics, we reviewed patients' records and conducted face-to-face interviews with the participants. We conducted descriptive and regression analyses using modified Poisson regression, accounting for data correlation of observation at the facility level to obtain prevalence ratios (PR) with 95% confidence intervals in Stata version 14.0.
413 participants were studied and 379 (91.8%) were interviewed. The participant's average age (SD) was 40 (10.7) years and 70.5% (267/379) were engaged in the fishing business. The prevalence of virological non-suppression was 88/413-21.3% (95% CI: 18%-26%). Factors associated with higher odds of virological non-suppression included: Age 26-50 years (adj.PR = 1.53, 95%CI: 1.11-2.08) and 15-25 years (adj.PR = 2.99, 95%CI: 1.27-7.05) compared to age above 50 years; unemployment (adj.PR = 1.28, 95%CI: 1.10-1.49); hazardous use of alcohol (adj.PR = 1.34, 95%CI: 1.10-1.62); non-mobility between fish landing sites (adj.PR = 1.37, 95%CI: 1.003-1.87); distant HIV treatment services (adj.PR = 1.37, 95%CI: 1.11-1.69) and TB diagnosis (adj.PR = 1.87, 95%CI: 1.33-2.64).
Virological non-suppression among people living with HIV in fishing communities along the shores of Lake Albert is alarmingly high, exceeding the UNAIDS threshold of 10% by two-fold. Several key determinants were identified, including hazardous alcohol use, unemployment, and access barriers to HIV treatment services.
病毒学上的未抑制是导致 HIV 传播率的关键因素，但对于这种现象的决定因素，特别是在 HIV 发病率不成比例高的渔业社区，可用的数据有限。我们旨在确定在布利萨区渔业社区接受艾滋病毒护理服务的成年男性（≥15 岁）中病毒学未抑制的流行率和决定因素。
我们对居住在渔业社区内、至少在六个提供艾滋病毒服务的卫生设施中接受了至少 6 个月护理的所有成年男性（≥15 岁）进行了横断面研究。为了获得有关患者和卫生机构特征的数据，我们查阅了患者的记录，并与参与者进行了面对面的访谈。我们使用修正泊松回归进行描述性和回归分析，考虑到设施水平观察的数据相关性，以获得在 Stata 版本 14.0 中的具有 95%置信区间的患病率比（PR）。
共研究了 413 名参与者，其中 379 名（91.8%）接受了访谈。参与者的平均年龄（SD）为 40（10.7）岁，其中 70.5%（267/379）从事渔业工作。病毒学未抑制的患病率为 88/413-21.3%（95%CI：18%-26%）。与年龄大于 50 岁的人相比，与较高的病毒学未抑制可能性相关的因素包括：年龄 26-50 岁（调整后的 PR = 1.53，95%CI：1.11-2.08）和 15-25 岁（调整后的 PR = 2.99，95%CI：1.27-7.05）；失业（调整后的 PR = 1.28，95%CI：1.10-1.49）；危险饮酒（调整后的 PR = 1.34，95%CI：1.10-1.62）；鱼上岸点之间的非流动性（调整后的 PR = 1.37，95%CI：1.003-1.87）；HIV 治疗服务距离较远（调整后的 PR = 1.37，95%CI：1.11-1.69）和结核病诊断（调整后的 PR = 1.87，95%CI：1.33-2.64）。
沿艾伯特湖岸边渔业社区中艾滋病毒感染者的病毒学未抑制率高得惊人，是联合国艾滋病规划署规定的 10%阈值的两倍。确定了一些关键决定因素，包括危险饮酒、失业以及获得艾滋病毒治疗服务的障碍。
