Department of Pediatrics and Child Health Nursing, School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
PLoS One. 2024 May 13;19(5):e0303243. doi: 10.1371/journal.pone.0303243. eCollection 2024.
For those HIV seropositive people with high viral loads, the World Health Organization recommends more counseling before changing ART regimens. A high viral load can lead to increased HIV transmission and lower survival rates. Clients with viral loads above 1000 copies/mL should receive enhanced adherence counseling for 3-6 months before switching. Despite enhanced adherence counseling programs, most countries struggle with viral load suppression. Little is known about viral load suppression in Ethiopia and the research area after counseling.
This study aims to assess viral load suppression and its predictors among HIV-positive individuals receiving enhanced adherence counseling in Bahir Dar, Northwest Ethiopia, in 2022.
An institution-based retrospective follow-up study was conducted among randomly selected 546 clients on Enhanced Adherence Counseling at public health facilities in Bahir Dar city. The Epicollect5 mobile application was used to collect the data, which was then exported to Stata version 14 for analysis. A Log-Binomial regression model was fitted for each explanatory variable. Variables having a p-value <0.25 in bivariate analysis were entered into a multivariable Log-Binomial regression model. Finally, an adjusted risk ratio with a 95% confidence interval and a p-value <0.05 was used to measure the strength of the prediction.
Following enhanced adherence counseling, 312 (57.1%) people had their viral load suppressed. Absence of recurrent OI (ARR 1.40; CI 1.03-1.91), EAC stay less than 3 months (ARR 1.54; CI 1.19-1.99), EAC stay 3-6 months (ARR 1.38; CI 1.12-1.69), once-daily ARV dose regimen (ARR 1.28; CI 1.03-1.58), baseline viral load of 2879.00 copies/ml (ARR 1.30, CI 1.06-1.60), being orthodox Tewahido Christian (ARR 0.37; CI 0.18-0.75) were significant predictors of viral load suppression after Enhanced Adherence Counseling.
Most importantly, this study found that most people had suppressed viral loads after receiving enhanced adherence counseling. Significant predictors of viral load suppression included recurrent OI, length of stay on EAC, daily ARV dosing regimen, baseline viral load, and religion. Clients with a high baseline viral load and those who experience recurring opportunistic infections should get extra care during EAC sessions.
对于那些病毒载量较高的 HIV 血清阳性者，世界卫生组织建议在改变 ART 方案之前进行更多的咨询。高病毒载量可导致 HIV 传播增加和生存率降低。病毒载量超过 1000 拷贝/ml 的患者应在转换前接受增强的依从性咨询 3-6 个月。尽管有增强的依从性咨询计划，但大多数国家仍难以实现病毒载量抑制。关于埃塞俄比亚和咨询后的研究领域的病毒载量抑制知之甚少。
本研究旨在评估 2022 年在埃塞俄比亚西北部的巴赫达尔，接受增强依从性咨询的 HIV 阳性个体中病毒载量抑制及其预测因素。
在巴赫达尔市的公共卫生设施中，对接受增强依从性咨询的 546 名随机选择的患者进行了基于机构的回顾性随访研究。使用 Epicollect5 移动应用程序收集数据，然后将其导出到 Stata 版本 14 进行分析。对每个解释变量进行逻辑二项式回归模型拟合。在单变量分析中 p 值 <0.25 的变量被纳入多变量逻辑二项式回归模型。最后，使用调整后的风险比和 95%置信区间以及 p 值 <0.05 来衡量预测的强度。
在接受增强依从性咨询后，有 312 人（57.1%）的病毒载量得到抑制。无复发性机会性感染（ARR 1.40；CI 1.03-1.91）、EAC 停留时间<3 个月（ARR 1.54；CI 1.19-1.99）、EAC 停留时间 3-6 个月（ARR 1.38；CI 1.12-1.69）、每日一次 ARV 剂量方案（ARR 1.28；CI 1.03-1.58）、基线病毒载量为 2879.00 拷贝/ml（ARR 1.30，CI 1.06-1.60）、正统特瓦希多基督教（ARR 0.37；CI 0.18-0.75）是增强依从性咨询后病毒载量抑制的显著预测因素。
最重要的是，本研究发现，大多数人在接受增强依从性咨询后病毒载量得到抑制。病毒载量抑制的显著预测因素包括复发性机会性感染、EAC 停留时间、每日 ARV 剂量方案、基线病毒载量和宗教。基线病毒载量较高且经常发生机会性感染的患者在 EAC 期间应得到额外的护理。
