Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Collaboration Unit for Infection, Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan.
PLoS One. 2024 Aug 14;19(8):e0307003. doi: 10.1371/journal.pone.0307003. eCollection 2024.
Tanzania has made significant progress in improving access to HIV care and treatment. However, virologic suppression among people living with HIV (PLHIV) has not been fully realized. In March 2019, Tanzania introduced a World Health Organization (WHO)-recommended dolutegravir-based regimen as the default first-line regimen. Eighteen months later we investigated the HIV viral suppression rates and the factors associated with lack of viral suppression among PLHIV (children and adults) in Tanzania.
A cross-sectional survey was conducted from September to December 2020 among PLHIV on antiretroviral therapy (ART) in Tanzania. Whole blood samples, demographic data and clinical information were obtained from eligible adults (≥15 years) and children (< 15 years) attending thirty-six HIV care and treatment centres located in 22 regions of Tanzania mainland. A whole blood sample from each participant was processed into plasma and HIV viral load was estimated using real-time PCR. HIV viral suppression was defined at a cut-off of < 50 copies/mL as recommended by WHO. Analyses were conducted using descriptive statistics to establish the national representative prevalence of viral suppression, and logistic regression analyses to determine independent factors associated with non-suppression.
A total of 2,039 PLHIV on ART were recruited; of these, adults and children were 57.5% (n = 1173) and 42.5% (n = 866), respectively. Among the adult population, the mean age and standard deviation (SD) was 42.1 ± 12.4 years, with 64.7% being female. Among children, the mean age and SD were 9.6 ± 3 years, and 53.2% were female. Overall viral suppression at < 50 copies/mL (undetectable) was achieved in 87.8% of adults and 74.4% of children. Adults and children on dolutegravir-based regimen recorded viral suppression rates of 89.7% and 85.1% respectively. Factors independently associated with lack of viral suppression status in the adult population were age and ART adherence while in the children population, the factors were sex, ART adherence, and current ART regimen (p<0.05).
Dolutegravir-based regimens are promising to help attain epidemic control in Tanzania. More efforts especially on ART adherence are needed to attain optimal treatment outcomes for children and adults PLHIV in Tanzania.
坦桑尼亚在改善艾滋病毒护理和治疗的可及性方面取得了重大进展。然而，艾滋病毒感染者（PLHIV）的病毒学抑制率尚未完全实现。2019 年 3 月，坦桑尼亚推出了世界卫生组织（WHO）推荐的多替拉韦为基础的方案，作为默认的一线治疗方案。18 个月后，我们调查了坦桑尼亚 PLHIV（儿童和成人）中缺乏病毒抑制的 HIV 病毒抑制率和相关因素。
2020 年 9 月至 12 月，在坦桑尼亚接受抗逆转录病毒疗法（ART）的 PLHIV 中进行了一项横断面调查。从位于坦桑尼亚大陆 22 个地区的 36 个艾滋病毒护理和治疗中心招募了符合条件的成年人（≥15 岁）和儿童（<15 岁）的全血样本、人口统计学数据和临床信息。从每个参与者中提取全血样本，制成血浆，使用实时 PCR 测定 HIV 病毒载量。按照世卫组织的建议，将<50 拷贝/ml 作为病毒抑制的截断值。采用描述性统计方法确定国家代表性的病毒抑制流行率，并采用逻辑回归分析确定与非抑制相关的独立因素。
共招募了 2039 名接受 ART 治疗的 PLHIV；其中，成年人和儿童分别占 57.5%（n=1173）和 42.5%（n=866）。在成年人群体中，平均年龄和标准差（SD）为 42.1±12.4 岁，其中 64.7%为女性。在儿童中，平均年龄和 SD 分别为 9.6±3 岁，其中 53.2%为女性。成年人中<50 拷贝/ml（不可检测）的总体病毒抑制率达到 87.8%，儿童中为 74.4%。接受多替拉韦为基础方案的成年人和儿童的病毒抑制率分别为 89.7%和 85.1%。与成年人缺乏病毒抑制状态相关的独立因素是年龄和 ART 依从性，而在儿童中，相关因素是性别、ART 依从性和当前的 ART 方案（p<0.05）。
多替拉韦为基础的方案有望帮助坦桑尼亚实现流行控制。需要在提高 ART 依从性方面做出更多努力，以实现坦桑尼亚 PLHIV 儿童和成人的最佳治疗效果。
