Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
University of California Global Health Institute, University of California San Francisco, San Francisco, CA, USA.
AIDS Res Ther. 2023 Dec 19;20(1):90. doi: 10.1186/s12981-023-00583-3.
BACKGROUND: Intensive adherence counseling (IAC) is the global standard of care for people living with human immunodeficiency virus (PLHIV) who have unsuppressed VL after ≥ 6 months of first-line anti-retroviral therapy (ART). We investigated whether the number of IAC sessions is associated with suppressed VL among PLHIV in Kampala, Uganda. METHODS: We conducted a nested case-control study among PLHIV with unsuppressed VL after ≥ 3 IAC sessions (cases) and a 2:1 random sample of PLHIV with suppressed VL after ≥ 3 IAC sessions (controls). Unsuppressed VL was defined as VL ≥ 1000 copies/ml. We performed multivariable logistic regression to identify factors that differed significantly between cases and controls. RESULTS: Demographic and clinical characteristics were similar among the 16 cases and 32 controls including mean age, sex, baseline CD4 count, VL before IAC, and WHO clinical stage. Only the number of IAC sessions differed significantly between cases and controls in unadjusted (p = 0.012) and adjusted (p = 0.016) analyses. Each unit increase in IAC session was associated with unsuppressed VL (Adjusted odds ratio 5.09; 95% CI 1.35-19.10). CONCLUSIONS: VL remained unsuppressed despite increasing IAC frequency. The fidelity to standardized IAC protocol besides drug resistance testing among PLHIV with unsuppressed VL before IAC commencement should be examined.
背景：强化依从性咨询（IAC）是对一线抗逆转录病毒治疗（ART）后≥6 个月病毒载量（VL）仍未抑制的人类免疫缺陷病毒（PLHIV）患者的全球护理标准。我们研究了在乌干达坎帕拉，IAC 次数是否与 PLHIV 的 VL 抑制有关。
方法：我们对接受≥3 次 IAC 后 VL 仍未抑制的 PLHIV（病例）和接受≥3 次 IAC 后 VL 抑制的 PLHIV（对照组）进行了嵌套病例对照研究。VL 未抑制定义为 VL≥1000 拷贝/ml。我们进行了多变量逻辑回归分析，以确定病例和对照组之间存在显著差异的因素。
结果：16 例病例和 32 例对照组的人口统计学和临床特征相似，包括平均年龄、性别、基线 CD4 计数、IAC 前 VL 和世界卫生组织临床分期。在未调整（p=0.012）和调整（p=0.016）分析中，只有 IAC 次数在病例和对照组之间存在显著差异。IAC 次数每增加一个单位，VL 未抑制的风险就会增加（调整后的比值比 5.09；95%置信区间 1.35-19.10）。
结论：尽管增加了 IAC 频率，但 VL 仍未得到抑制。在开始 IAC 之前，应检查 PLHIV 中是否遵守标准化 IAC 方案以及耐药性检测。
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