Ainembabazi Bridget, Ssebunya Rogers N, Akobye Winnie, Mugume Alexander, Nahirya-Ntege Patricia, Birungi Denise J, Maganda Albert K, Elyanu Peter J, Kiragga Dithan
USAID Local Partner Health Services - Eastern, Mbale, Uganda.
Baylor College of Medicine Children's Foundation, Kampala, Uganda.
BMC Pediatr. 2024 Dec 7;24(1):804. doi: 10.1186/s12887-024-05295-9.
In July 2022, Uganda's Ministry of Health extended the 2021 WHO guidelines that recommended 3-6 monthly dispensing of antiretroviral therapy (ART) to include all children and adolescents living with HIV (CALHIV). Treatment outcomes following this recommendation have not yet been documented. We compared viral load (VL) suppression and retention in HIV care rates among CALHIV receiving 1, 2-5, and > = 6 monthly ART dispensation in Uganda.
A cross-sectional study of electronic medical records in 118 health facilities was conducted. Data for CALHIV 10-19 years captured at their most recent five clinic visits as of 15th May 2023 were analysed. Most recent two VL < 1000 copies/ml were used as measures for VL suppression and sustained VL suppression. A client was considered retained in care if they visited the clinic within 28 days from their expected return visit date. We used margins plots and a modified poisson model adjusting for facility level clustering to assess VL suppression and retention across multi-month ART categories.
A total of 2864 CALHIV, 1609 (56.2%) being females and with a median age of 12 years (inter quartile range, iqr = 7) were included. Overall suppression and retention rates were 80.4% (2133/2654) and 87.8% (2514/2864) respectively. A significant number had been dispensed ART for ≥ 2 months (50%, 2-5 months and 43.5%, ≥ 6 months). Probability of having a suppressed VL was higher among CALHIV that had received ≥ 6 months and 2-5 months of ART compared to those of 1 month i.e., 83% vs 79% vs 41% respectively. Probability of being retained in care didn't differ across multi-month ART categories. CALHIV who received ART for 2-5 months and ≥ 6 months compared to 1 month were more likely to have a suppressed VL; (adj.PR = 1.98; 95%CI:1.41, 2.80) and (adj.PR = 2.21; 95% CI:1.59, 3.05) respectively. CALHIV with a Tuberculosis diagnosis history were less likely to have a suppressed VL (adj.PR = 0.73; 95%CI:0.65,0.81), however this was not statistically significantly different between multi-month categories.
CALHIV receiving multi-month ART including 6 months dispensation had better VL suppression rates. Retention rates however didn't differ by multi-month dispensing categories as observed among adults in the interval trial. We recommend multi-month ART dispensation including more than 6 months among CALHIV irrespective of their age, clinical stage, and history of prior co-morbidities.
2022年7月，乌干达卫生部扩展了2021年世界卫生组织的指南，该指南建议每3 - 6个月发放一次抗逆转录病毒疗法（ART），将所有感染艾滋病毒的儿童和青少年（CALHIV）纳入其中。这一建议实施后的治疗结果尚未有记录。我们比较了乌干达接受每月1次、2 - 5次以及≥6次ART发放的CALHIV的病毒载量（VL）抑制情况和艾滋病毒护理留存率。
对118个医疗机构的电子病历进行了横断面研究。分析了截至2023年5月15日在最近五次门诊就诊时记录的10 - 19岁CALHIV的数据。最近两次VL<1000拷贝/毫升被用作VL抑制和持续VL抑制的衡量指标。如果患者在预期复诊日期后的28天内到诊所就诊，则被视为仍在接受护理。我们使用边际图和调整了机构层面聚类的修正泊松模型来评估不同多月ART类别的VL抑制和留存情况。
共纳入2864名CALHIV，其中1609名（56.2%）为女性，中位年龄为12岁（四分位间距，iqr = 7）。总体抑制率和留存率分别为80.4%（2133/2654）和87.8%（2514/2864）。相当数量的患者已接受ART≥2个月（50%，2 - 5个月和43.5%，≥6个月）。与接受1个月ART的CALHIV相比，接受≥6个月和2 - 5个月ART的CALHIV的VL被抑制的概率更高，分别为83%、79%和41%。多月ART类别之间的护理留存概率没有差异。与接受1个月ART相比，接受2 - 5个月和≥6个月ART的CALHIV更有可能出现VL被抑制的情况；（调整后PR = 1.98；95%CI：1.41，2.80）和（调整后PR = 2.21；95%CI：1.59，3.05）。有结核病诊断史的CALHIV出现VL被抑制的可能性较小（调整后PR = 0.73；95%CI：0.65，0.81），然而在多月类别之间这一差异无统计学意义。
接受包括6个月发放量在内的多月ART的CALHIV有更好的VL抑制率。然而，留存率在多月发放类别之间没有差异，这与成人区间试验中的观察结果一致。我们建议在CALHIV中实施多月ART发放，包括超过6个月的发放量，无论其年龄、临床阶段和既往合并症病史如何。
