Quaker Andrewleon S, Shirima Laura J, Msuya Sia E
Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.
Regional Health Management Team, Regional Secretariat, Kilimanjaro, Tanzania.
Front Reprod Health. 2024 Jan 15;6:1309740. doi: 10.3389/frph.2024.1309740. eCollection 2024.
Tanzania is one of the countries with a high burden of HIV. It has an estimated 1.4 million people living with HIV in 2021. Adolescents living with HIV on antiretroviral therapy (ART) have worse treatment adherence, viral suppression, and mortality rates compared to adults. This study aim was to determine the trend of non-suppression among adolescents on ART in Tanzania from 2018 to 2021 and latest associated predictors.
The study utilized data of adolescents (10-19 years) receiving ART in Tanzania mainland for the period of 2018-2021 from the National Care and Treatment Centers database. The primary outcome of interest was non-suppression of viral load, defined as a VL above 1,000 copies/ml. The study employed multivariable logistic regression models to identify factors associated with non-suppression of VL. STATA 15 statistical software was used to analyze the data.
Records of 65,942 adolescents present in the CTC database Tanzania were analyzed. Approximately more than half were female 38,544 (58.5%). The proportion of non-suppression was 34.5%, 23.3%, 12.1%, and 9.7% for the years 2018-2021, respectively. After adjusting for other factors, adolescents with a history of poor adherence to ART in the last six months had higher odds of non-suppression (OR = 1.95, 95% CI = 1.64, 2.31). Adolescents on second or third line ART regimens were almost two times more likely to be non-suppressed compared to those on first-line regimens (OR = 2.85, 95% CI = 2.52, 3.23). Girls had lower odds of non-suppression compared to boys (OR = 0.91, 95% CI = 0.84, 0.98), and similarly, patients attending hospitals had lower odds compared to those attending dispensaries (OR = 0.79, 95% CI = 0.72, 0.87).
Being female, having good history of adherence over the last six months, and attending hospital level was significantly associated with lower levels of non-suppression, while being on second line ART or attending lower health facilities increased the odds of non-suppression. Efforts to enhance the quality and capacity of health services at lower-level facilities (dispensaries and health centers) should be prioritized, as well as promoting gender-sensitive approaches that take into account the unique needs and experiences of adolescent girls and boys are needed to improve VL suppression among this population.
坦桑尼亚是艾滋病毒负担较高的国家之一。据估计，2021年该国约有140万人感染艾滋病毒。与成年人相比，接受抗逆转录病毒疗法（ART）的青少年艾滋病毒感染者在治疗依从性、病毒抑制和死亡率方面情况更差。本研究旨在确定2018年至2021年坦桑尼亚接受抗逆转录病毒治疗的青少年中病毒未得到抑制的趋势以及最新的相关预测因素。
该研究利用了2018 - 2021年期间坦桑尼亚大陆国家护理和治疗中心数据库中接受抗逆转录病毒治疗的青少年（10 - 19岁）的数据。主要关注的结果是病毒载量未得到抑制，定义为病毒载量高于1000拷贝/毫升。该研究采用多变量逻辑回归模型来确定与病毒载量未得到抑制相关的因素。使用STATA 15统计软件对数据进行分析。
对坦桑尼亚综合治疗中心（CTC）数据库中的65942名青少年记录进行了分析。约一半以上为女性，共38544人（58.5%）。2018 - 2021年期间病毒未得到抑制的比例分别为34.5%、23.3%、12.1%和9.7%。在调整其他因素后，过去六个月抗逆转录病毒治疗依从性差的青少年病毒未得到抑制的几率更高（比值比[OR]=1.95，95%置信区间[CI]=1.64，2.31）。与接受一线治疗方案的青少年相比，接受二线或三线抗逆转录病毒治疗方案的青少年病毒未得到抑制的可能性几乎高出两倍（OR = 2.85，95% CI = 2.52，3.23）。女孩病毒未得到抑制的几率低于男孩（OR = 0.91，95% CI = 0.84，0.98），同样，在医院就诊的患者病毒未得到抑制的几率低于在诊所就诊的患者（OR = 0.79，95% CI = 0.72，0.87）。
女性、过去六个月有良好的依从史以及在医院就诊与较低的病毒未得到抑制水平显著相关，而接受二线抗逆转录病毒治疗或在较低级别的医疗机构就诊会增加病毒未得到抑制的几率。应优先努力提高较低级别医疗机构（诊所和卫生中心）的卫生服务质量和能力，同时需要推广考虑到青少年女孩和男孩独特需求和经历的性别敏感方法，以改善这一人群的病毒抑制情况。
