Division of Social and Behavioural Sciences, School of Public Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Centre for Social Science Research, University of Cape Town, Cape Town, South Africa.
J Acquir Immune Defic Syndr. 2024 Jun 1;96(2):171-179. doi: 10.1097/QAI.0000000000003408.
BACKGROUND: Compared with other age groups, adolescents living with HIV (ALHIV) are estimated to have lower levels of adherence to antiretroviral treatment. Despite this, we lack evidence on adolescents' adherence patterns over time to inform the customization of intervention strategies. SETTING: Eastern Cape province, South Africa. METHODS: We analyzed data from a cohort of ALHIV (N = 1046, aged 10-19 years at baseline) recruited from 53 public health facilities. The cohort comprised 3 waves of data collected between 2014 and 2018 and routine viral load data from the National Institute for Communicable Disease data warehouse (2014-2019). Durable viral suppression was defined as having suppressed viral load (<1000 copies/mL) at ≥2 consecutive study waves. Group-based multitrajectory model was used to identify adherence trajectories using 5 indicators of self-reported adherence. Logistic regression modeling evaluated the associations between adherence trajectories and durable viral suppression. RESULTS: Overall, 933 ALHIV (89.2%) completed all 3 study waves (55.1% female, mean age: 13.6 years at baseline). Four adherence trajectories were identified, namely, "consistent adherence" (49.8%), "low start and increasing" (20.8%), "gradually decreasing" (23.5%), and "low and decreasing" (5.9%). Adolescents experiencing inconsistent adherence trajectories were more likely to be older, live in rural areas, and have sexually acquired HIV. Compared with the consistent adherence trajectory, the odds of durable viral suppression were lower among adolescents in the low start and increasing (adjusted odds ratio [aOR]: 0.62, 95% CI: 0.41 to 0.95), gradually decreasing (aOR: 0.40, 95% CI: 0.27 to 0.59), and the low and decreasing adherence (aOR: 0.25, 95% CI: 0.10 to 0.62) trajectories. CONCLUSIONS: Adherence to antiretroviral treatment remains a challenge among ALHIV in South Africa. Identifying adolescents at risk of nonadherence, based on their adherence trajectories may inform the tailoring of adolescent-friendly support strategies.
背景：与其他年龄组相比，感染艾滋病毒的青少年（ALHIV）估计其抗逆转录病毒治疗的依从性较低。尽管如此，我们缺乏有关青少年随时间推移的依从模式的证据，无法为干预策略的定制提供信息。
地点：南非东开普省。
方法：我们分析了来自 53 个公共卫生机构的一组 ALHIV（N=1046 人，基线时年龄为 10-19 岁）队列的数据。该队列由 2014 年至 2018 年收集的 3 波数据以及国家传染病研究所数据仓库的常规病毒载量数据（2014-2019 年）组成。持久病毒抑制定义为在至少 2 次连续研究波中均具有抑制的病毒载量（<1000 拷贝/mL）。使用 5 项自我报告的依从性指标，使用基于群组的多轨迹模型确定依从性轨迹。逻辑回归模型评估了依从性轨迹与持久病毒抑制之间的关联。
结果：总体而言，有 933 名 ALHIV（89.2%）完成了所有 3 个研究波（55.1%为女性，基线时平均年龄为 13.6 岁）。确定了 4 种依从性轨迹，即“一致依从”（49.8%），“低起点和增加”（20.8%），“逐渐减少”（23.5%）和“低且减少”（5.9%）。经历不一致依从轨迹的青少年年龄较大，生活在农村地区，并且通过性途径感染艾滋病毒。与一致依从轨迹相比，在低起点和增加（调整后的优势比[OR]：0.62，95%置信区间[CI]：0.41 至 0.95），逐渐减少（调整后的 OR：0.40，95%CI：0.27 至 0.59）和低且减少依从（调整后的 OR：0.25，95%CI：0.10 至 0.62）轨迹的青少年中，持久病毒抑制的可能性较低。
结论：在南非，青少年抗逆转录病毒治疗的依从性仍然是一个挑战。根据青少年的依从轨迹确定有不依从风险的青少年，可以为制定适合青少年的支持策略提供信息。
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