Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania.
Trop Med Int Health. 2024 Sep;29(9):792-800. doi: 10.1111/tmi.14031. Epub 2024 Aug 4.
Adolescents and young adults (AYA) living with HIV have been shown to have lower rates of viral load testing and viral suppression as compared to older adults. We examined trends over time and predictors of HIV viral load monitoring and viral suppression among AYA in a large HIV treatment programme in Dar es Salaam, Tanzania.
We analysed longitudinal data of AYA aged 10-24 years initiated on antiretroviral therapy between January 2017 and October 2022. Trend models were used to assess changes in HIV viral load testing and viral suppression by calendar year. Generalised estimating equations were used to examine the relationship of sociodemographic and clinical factors with HIV viral load testing and viral suppression.
Out of 15,759 AYA, the percentage of those who received a 6-month HIV viral load testing increased from 40.6% in 2017 to 64.7% in 2022 and, a notable annual increase of 5.6% (p < 0.001). A higher HIV viral load testing uptake was observed among 20- to 24-year-olds (87.7%) compared to 10- to 19-year-olds (80.2%) (p < 0.001). The likelihood of not receiving an HIV viral load test within 12 months of antiretroviral therapy initiation was higher among 10- to 19-year-olds (adjusted odds ratio [aOR] = 1.7; 95% confidence interval [CI] = 1.4-2.0), advanced HIV disease (aOR = 1.3; 95% CI = 1.12-1.53), normal nutrition status at enrolment aOR 2.6 (95% CI = 1.59-4.26) and initiation of non-nucleoside reverse transcriptase inhibitors regimen aOR 1.2 (95% CI = 1.08-1.34). The proportion of AYA with viral suppression increased from 83.0% in 2017 to 94.6% in 2022. Notably, the overall trend in viral suppression increased significantly at 2.4% annually. The risk of not achieving viral suppression was greater among 10- to 14-year-olds (aOR = 2; 95% CI = 1.75-2.43) and 15- to 19-year-olds (aOR = 1.4; 95% CI = 1.24-1.58) as compared to 20-24 years; being male (aOR = 1.16; 95% CI = 1.02-1.32); undernourished (aOR = 1.53; 95% CI = 1.17-1.99); in WHO Stage II (aOR = 1.16; 95% CI = 1.02-1.33) and III (aOR = 1.21; 95% CI = 1.03-1.42) and being on an non-nucleoside reverse transcriptase inhibitors regimen (aOR = 1.32; 95% CI = 1.18-1.48).
HIV viral load testing uptake at 6 months of antiretroviral therapy initiation and viral suppression increased from 2017 to 2022; however, overall HIV viral load testing was suboptimal. Demographic and clinical characteristics can be used to identify AYA at greater risk for not having HIV viral load test and not achieving viral suppression.
与年龄较大的成年人相比，青少年和年轻人（AYA）携带艾滋病毒的人群病毒载量检测和病毒抑制率较低。我们研究了在坦桑尼亚达累斯萨拉姆的一个大型艾滋病毒治疗项目中，随着时间的推移，AYA 中 HIV 病毒载量监测和病毒抑制的趋势及其预测因素。
我们分析了 2017 年 1 月至 2022 年 10 月期间开始接受抗逆转录病毒治疗的 10-24 岁 AYA 的纵向数据。使用趋势模型评估按日历年度 HIV 病毒载量检测和病毒抑制的变化。使用广义估计方程研究社会人口统计学和临床因素与 HIV 病毒载量检测和病毒抑制的关系。
在 15759 名 AYA 中，接受 6 个月 HIV 病毒载量检测的比例从 2017 年的 40.6%增加到 2022 年的 64.7%，每年显著增加 5.6%（p<0.001）。20-24 岁人群的 HIV 病毒载量检测率明显高于 10-19 岁人群（87.7%对 80.2%）（p<0.001）。在开始抗逆转录病毒治疗后 12 个月内未接受 HIV 病毒载量检测的可能性在 10-19 岁人群中更高（调整后的优势比[aOR]为 1.7；95%置信区间[CI]为 1.4-2.0），艾滋病毒疾病晚期（aOR=1.3；95%CI=1.12-1.53），在入组时营养状况正常（aOR 为 2.6；95%CI 为 1.59-4.26）和起始非核苷逆转录酶抑制剂方案（aOR 为 1.2；95%CI 为 1.08-1.34）。AYA 的病毒抑制比例从 2017 年的 83.0%增加到 2022 年的 94.6%。值得注意的是，病毒抑制的总体趋势以每年 2.4%的速度显著增加。10-14 岁和 15-19 岁的儿童与 20-24 岁的儿童相比，无法达到病毒抑制的风险更高（aOR 分别为 2 和 1.4；95%CI 分别为 1.75-2.43 和 1.24-1.58）；男性（aOR 为 1.16；95%CI 为 1.02-1.32）；营养不良（aOR 为 1.53；95%CI 为 1.17-1.99）；在世界卫生组织（WHO）分期 II（aOR 为 1.16；95%CI 为 1.02-1.33）和 III 期（aOR 为 1.21；95%CI 为 1.03-1.42）和使用非核苷逆转录酶抑制剂方案（aOR 为 1.32；95%CI 为 1.18-1.48）。
从 2017 年到 2022 年，开始抗逆转录病毒治疗后 6 个月的 HIV 病毒载量检测率和病毒抑制率有所增加；然而，总体 HIV 病毒载量检测情况仍不理想。人口统计学和临床特征可用于识别 HIV 病毒载量检测和未达到病毒抑制的风险更高的 AYA。
