COVID-19 大流行对肯尼亚常规 HIV 护理和抗逆转录病毒治疗结果的影响：一项全国代表性分析。
Impact of the COVID-19 pandemic on routine HIV care and antiretroviral treatment outcomes in Kenya: A nationally representative analysis.
机构信息
Division for Global HIV & TB (DGHT), Center for Global Health, US Centres for Disease Control and Prevention (CDC), Nairobi, Kenya.
National AIDS and STI Control Program (NASCOP), Ministry of Health, Nairobi, Kenya.
出版信息
PLoS One. 2023 Nov 27;18(11):e0291479. doi: 10.1371/journal.pone.0291479. eCollection 2023.
BACKGROUND
The COVID-19 pandemic adversely disrupted global health service delivery. We aimed to assess impact of the pandemic on same-day HIV diagnosis/ART initiation, six-months non-retention and initial virologic non-suppression (VnS) among individuals starting antiretroviral therapy (ART) in Kenya.
METHODS
Individual-level longitudinal service delivery data were analysed. Random sampling of individuals aged >15 years starting ART between April 2018 -March 2021 was done. Date of ART initiation was stratified into pre-COVID-19 (April 2018 -March 2019 and April 2019 -March 2020) and COVID-19 (April 2020 -March 2021) periods. Mixed effects generalised linear, survival and logistic regression models were used to determine the effect of COVID-19 pandemic on same-day HIV diagnosis/ART initiation, six-months non-retention and VnS, respectively.
RESULTS
Of 7,046 individuals sampled, 35.5%, 36.0% and 28.4% started ART during April 2018 -March 2019, April 2019 -March 2020 and April 2020 -March 2021, respectively. Compared to the pre-COVID-19 period, the COVID-19 period had higher same-day HIV diagnosis/ART initiation (adjusted risk ratio [95% CI]: 1.09 [1.04-1.13], p<0.001) and lower six-months non-retention (adjusted hazard ratio [95% CI]: 0.66 [0.58-0.74], p<0.001). Of those sampled, 3,296 (46.8%) had a viral load test done at a median 6.2 (IQR, 5.3-7.3) months after ART initiation. Compared to the pre-COVID-19 period, there was no significant difference in VnS during the COVID-19 period (adjusted odds ratio [95% CI]: 0.79 [95%% CI: 0.52-1.20], p = 0.264).
CONCLUSIONS
In the short term, the COVID-19 pandemic did not have an adverse impact on HIV care and treatment outcomes in Kenya. Timely, strategic and sustained COVID-19 response may have played a critical role in mitigating adverse effects of the pandemic and point towards maturity, versatility and resilience of the HIV program in Kenya. Continued monitoring to assess long-term impact of the COVID-19 pandemic on HIV care and treatment program in Kenya is warranted.
背景
COVID-19 大流行严重扰乱了全球卫生服务的提供。我们旨在评估该大流行对肯尼亚开始接受抗逆转录病毒治疗（ART）的个体中当天 HIV 诊断/ART 开始、六个月非保留和初始病毒学无抑制（VnS）的影响。
方法
对个体层面的纵向服务提供数据进行了分析。对 2018 年 4 月至 2021 年 3 月期间年龄大于 15 岁开始接受 ART 的个体进行了随机抽样。ART 开始日期分为 COVID-19 前（2018 年 4 月至 2019 年 3 月和 2019 年 4 月至 2020 年 3 月）和 COVID-19 期间（2020 年 4 月至 2021 年 3 月）。使用混合效应广义线性、生存和逻辑回归模型，分别确定 COVID-19 大流行对当天 HIV 诊断/ART 开始、六个月非保留和 VnS 的影响。
结果
在抽样的 7046 名个体中，分别有 35.5%、36.0%和 28.4%在 2018 年 4 月至 2019 年 3 月、2019 年 4 月至 2020 年 3 月和 2020 年 4 月至 2021 年 3 月开始接受 ART。与 COVID-19 前时期相比，COVID-19 时期当天 HIV 诊断/ART 开始的比例更高（调整风险比[95%CI]：1.09[1.04-1.13]，p<0.001），六个月非保留率较低（调整危险比[95%CI]：0.66[0.58-0.74]，p<0.001）。在抽样的个体中，有 3296 人（46.8%）在 ART 开始后中位数为 6.2（IQR，5.3-7.3）个月时进行了病毒载量检测。与 COVID-19 前时期相比，COVID-19 期间 VnS 没有显著差异（调整优势比[95%CI]：0.79[95%CI：0.52-1.20]，p=0.264）。
结论
在短期内，COVID-19 大流行对肯尼亚的 HIV 护理和治疗结果没有产生不利影响。及时、战略性和持续的 COVID-19 应对可能在减轻大流行的不利影响方面发挥了关键作用，并突显了肯尼亚 HIV 规划的成熟度、多功能性和弹性。需要继续监测以评估 COVID-19 大流行对肯尼亚 HIV 护理和治疗方案的长期影响。
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