School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
Schools of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
BMC Public Health. 2024 Oct 20;24(1):2887. doi: 10.1186/s12889-024-20396-x.
Human immunodeficiency virus (HIV), a viral infection impacting CD4 cells, requires an understanding of factors influencing CD4 cell counts to reduce acquired immunodeficiency syndrome(AIDS)-related morbidity and mortality. Despite its importance, no studies have examined predictors of CD4 cell count progression post-transition to adult-oriented HIV care in Ethiopia. This study aimed to identify predictors affecting CD4 cell count trends among adolescents and young adults transitioning to adult-oriented HIV care. Therefore, this study aimed to identify the predictors that affect the trends of CD4 cell count over time among adolescents and young adults who transitioned to adult-oriented HIV care.
A retrospective cohort study was conducted among 206 adolescents and young adults who transitioned to adult-oriented HIV care and had at least two CD4 cell counts in eight selected health facilities in Southern Ethiopia. These facilities were chosen due to their high volume of people living with HIV. A multivariable linear mixed effect model was fitted to identify the predictors of CD4 cell count progression through time. Multi-collinearity between variables was checked using the variance inflation factor. Model comparisons were done using Akaike and Bayesian information criteria. Regression coefficients with 95% confidence intervals (CI) and P-value ≤ 0.05 were used to measure the strength of association and significance level.
The average CD4 cell count was raised by 6.7 cells/mm every six months among the study participants. Transitioning at the age of 18 or older (β = 204.71; 95% CI = 81.86347, 327.5574; P < 0.001), being rural residents (β= -119.776; 95% CI = -215.362, -24.189; P < 0.014), having World Health Organization (WHO) stage III & IV HIV (β= -182.161; 95% CI = -318.475, -45.847; P < 0.009), were the predictors for CD4 cell count progression over time.
Based on the identified predictors of CD4 cell count progression over time among HIV-positive adolescents and young adults transitioning to adult-oriented HIV care in southern Ethiopia, such as observation time, age at transition, residence, and WHO staging, the study highlights the need for interventions focused on tailored support. Specifically, these interventions should target individuals transitioning with less ART time, those younger than 18, those residing in rural areas, and those with advanced WHO staging, to improve their CD4 cell counts over time.
人类免疫缺陷病毒（HIV）是一种影响 CD4 细胞的病毒感染，需要了解影响 CD4 细胞计数的因素，以降低与获得性免疫缺陷综合征（AIDS）相关的发病率和死亡率。尽管这一点很重要，但在埃塞俄比亚，尚无研究探讨青少年和青年向成人导向的 HIV 护理过渡后 CD4 细胞计数进展的预测因素。本研究旨在确定影响向成人导向的 HIV 护理过渡的青少年和青年的 CD4 细胞计数趋势的预测因素。因此，本研究旨在确定影响向成人导向的 HIV 护理过渡的青少年和青年的 CD4 细胞计数随时间变化趋势的预测因素。
在埃塞俄比亚南部的 8 家选定的卫生机构中，对 206 名向成人导向的 HIV 护理过渡并至少有两次 CD4 细胞计数的青少年和青年进行了回顾性队列研究。这些机构之所以被选中，是因为它们有大量的艾滋病毒感染者。采用多变量线性混合效应模型来确定随着时间的推移 CD4 细胞计数进展的预测因素。使用方差膨胀因子检查变量之间的多重共线性。使用赤池信息准则和贝叶斯信息准则进行模型比较。使用 95%置信区间（CI）和 P 值≤0.05 的回归系数来衡量关联强度和显著性水平。
研究参与者的平均 CD4 细胞计数每 6 个月增加 6.7 个细胞/mm。18 岁或以上过渡（β=204.71；95%CI=81.86347,327.5574；P<0.001）、农村居民（β=-119.776；95%CI=-215.362，-24.189；P<0.014）、世界卫生组织（WHO）分期 III 和 IV HIV（β=-182.161；95%CI=-318.475，-45.847；P<0.009）是随着时间推移 CD4 细胞计数进展的预测因素。
根据在埃塞俄比亚南部向成人导向的 HIV 护理过渡的 HIV 阳性青少年和青年中确定的 CD4 细胞计数随时间变化的预测因素，如观察时间、过渡时的年龄、居住地和世卫组织分期，研究强调需要针对特定人群开展以量身定制的支持为重点的干预措施。具体而言，这些干预措施应针对接受治疗时间较短、年龄小于 18 岁、居住在农村地区以及世卫组织分期较高的个体，以提高他们的 CD4 细胞计数随时间的变化。
