School of biomedical sciences, department of pharmacology and therapeutics, Makerere University College of Health Sciences, Kampala, Uganda.
Makerere University, Johns Hopkins University Collaboration (MU-JHU), Upper Mulago Hill Road, Kampala, Uganda.
AIDS Res Ther. 2024 Oct 24;21(1):74. doi: 10.1186/s12981-024-00661-0.
Protease inhibitor (PI)-based Antiretroviral Therapy (ART) regimens are key drugs in HIV management, especially when used as second line drugs. However, some PI-based ART have high adherence demands or tolerable adverse effects which may affect adherence and subsequently viral suppression. We assessed the extent of viral suppression, its determinants, and the experiences of clients on PI-based ART undergoing intensive adherence counselling (IAC) in a public HIV clinic.
Mixed methods sequential explanatory study involving a quantitative retrospective chart review for clients on PI-based ART who had received IAC from Dec 2016 to May 2023 and qualitative interviews for clients on PI-based ART who had received IAC in the past six months at an urban public HIV clinic in Uganda.
In this study, a total of 189 client charts were included. The median number of IAC sessions received was three (interquartile range, IQR, of 3 to 4) with median time of receiving IAC of three ( IQR, of 2 to 4). One half (51%, 95/186) of the clients had achieved viral suppression and the odds of suppression increased by 30% for every additional month on IAC. Respondents perceived the effectiveness of PI-based ART and IAC in achieving and supporting viral suppression, respectively.
Despite the perceived effectiveness of PI-based ART and IAC, suboptimal levels of viral suppression were observed among clients on PI-based ART who had received IAC. Therefore, it is important to provide IAC for optimal duration as it increases the chances of viral suppression. Further investigation of the barriers of viral suppression for clients on PI-based ART undergoing IAC is needed.
蛋白酶抑制剂（PI）为基础的抗逆转录病毒疗法（ART）方案是 HIV 管理的关键药物，尤其是在作为二线药物使用时。然而，一些基于 PI 的 ART 需要高度的依从性或可耐受的不良反应，这可能会影响依从性，并随后影响病毒抑制。我们评估了在一家公立 HIV 诊所中，接受强化依从性咨询（IAC）的基于 PI 的 ART 患者的病毒抑制程度、其决定因素以及患者的经验。
采用混合方法顺序解释性研究，对 2016 年 12 月至 2023 年 5 月期间接受过 IAC 的基于 PI 的 ART 患者进行了定量回顾性图表审查，对过去六个月内在乌干达一家城市公立 HIV 诊所接受过 IAC 的基于 PI 的 ART 患者进行了定性访谈。
在这项研究中，共纳入了 189 份患者图表。接受 IAC 的平均次数为 3 次（四分位距，IQR，3 至 4），接受 IAC 的平均时间为 3 个月（IQR，2 至 4）。一半（51%，95/186）的患者达到了病毒抑制，每额外接受一个月的 IAC，抑制的几率增加 30%。受访者认为 PI 为基础的 ART 和 IAC 分别在实现和支持病毒抑制方面有效。
尽管基于 PI 的 ART 和 IAC 被认为有效，但接受过 IAC 的基于 PI 的 ART 患者的病毒抑制水平仍不理想。因此，提供最佳时长的 IAC 以增加病毒抑制的机会非常重要。需要进一步调查接受 IAC 的基于 PI 的 ART 患者病毒抑制的障碍。
