Facha Wolde, Tadesse Takele, Wolka Eskinder, Astatkie Ayalew
Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
Front Public Health. 2024 Jul 2;12:1385441. doi: 10.3389/fpubh.2024.1385441. eCollection 2024.
The effect of dolutegravir (DTG)-based regimens on reducing attrition from care among women enrolled in the prevention of mother-to-child transmission (PMTCT) care program is unknown. Therefore, this study aimed to compare the incidence of attrition among women exposed to DTG-based with those exposed to efavirenz (EFV)-based first-line antiretroviral therapy (ART) in Ethiopia.
An uncontrolled before-and-after study was conducted involving 932 women (with 466 on EFV-based and 466 on DTG-based regimens) who were enrolled in the PMTCT care program from September 2015 to February 2023. The outcome variable was attrition (i.e., maternal death or loss to follow-up before their infants' final HIV status was determined). A Kaplan-Meier estimator was employed to estimate the probability of attrition. The Cox proportional hazards regression model was fitted to identify predictor variables. The adjusted hazard ratio (aHR) with the corresponding 95% confidence interval (CI) was calculated to examine the risk difference in the comparison groups.
The cumulative incidence of attrition among women was 5.2% (3.0% for those placed in the DTG-based regimen arm and 7.3% for those placed in the EFV-based regimen arm). Women on DTG-based regimens had a 57% (aHR: 0.43; 95% CI: 0.23-0.80) lower risk of attrition from care compared to those on EFV-based regimens. Women who delivered their infants at home (aHR: 2.35; 95% CI: 1.14-4.85), had poor/fair adherence (aHR: 3.23; 95% CI: 1.62-6.45), had unsuppressed/unknown viral load status (aHR: 2.61; 95% CI: 1.42-4.79), and did not disclose their status to partners (aHR: 2.56; 95% CI: 1.34-4.92) had a higher risk of attrition from PMTCT care compared to their counterparts.
The cumulative incidence of attrition among women receiving PMTCT care is optimal. In addition, the risk of attrition among women receiving DTG-based regimens is lower than that among women receiving EFV-based regimens. Thus, DTG-based first-line ART regimen supplementation should be sustained to achieve a national retention target of 95% and above.
基于多替拉韦（DTG）的治疗方案对降低参与预防母婴传播（PMTCT）护理项目的女性护理失访率的影响尚不清楚。因此，本研究旨在比较埃塞俄比亚接受基于DTG的一线抗逆转录病毒疗法（ART）的女性与接受基于依非韦伦（EFV）的一线抗逆转录病毒疗法的女性的失访发生率。
进行了一项非对照前后研究，纳入了932名于2015年9月至2023年2月期间参与PMTCT护理项目的女性（466名接受基于EFV的治疗方案，466名接受基于DTG的治疗方案）。结局变量为失访（即母亲死亡或在其婴儿最终HIV状态确定之前失访）。采用Kaplan-Meier估计量来估计失访概率。采用Cox比例风险回归模型来确定预测变量。计算调整后的风险比（aHR）及相应的95%置信区间（CI），以检验比较组之间的风险差异。
女性的累积失访发生率为5.2%（基于DTG治疗方案组为3.0%，基于EFV治疗方案组为7.3%）。与接受基于EFV治疗方案的女性相比，接受基于DTG治疗方案的女性护理失访风险降低了57%（aHR：0.43；95%CI：0.23 - 0.80）。在家分娩的女性（aHR：2.35；95%CI：1.14 - 4.85）、依从性差/一般的女性（aHR：3.23；95%CI：1.62 - 6.45）、病毒载量未得到抑制/情况不明的女性（aHR：2.61；95%CI：1.42 - 4.79）以及未向伴侣披露自身状况的女性（aHR：2.56；95%CI：1.34 - 4.92），与对应女性相比，PMTCT护理失访风险更高。
接受PMTCT护理的女性累积失访发生率处于最佳水平。此外，接受基于DTG治疗方案的女性失访风险低于接受基于EFV治疗方案的女性。因此，应持续补充基于DTG的一线ART治疗方案，以实现95%及以上的全国留存率目标。
