Bikinesi Leonard, Spinelli Matthew A, Nyoni Ntombizodwa, Mouton Daniella, Mengistu Assegid, Kamangu Jacques, Konstantinus Iyaloo, Kalimugogo Pearl, Mutandi Gram, Negussie Fekir, Wang Guohong, Welty Susie, McFarland Willi, Beard R Suzanne, Haberer Jessica, McCluskey Suzanne, Gandhi Monica, Hong Steven Y
Ministry of Health and Social Services, Windhoek, Namibia.
Division of HIV, Infectious Diseases and Global Medicine, University of California San Francisco (UCSF), USA.
Int J Infect Dis. 2025 Feb;151:107328. doi: 10.1016/j.ijid.2024.107328. Epub 2024 Dec 6.
OBJECTIVES: To examine if point-of-care (POC) urine tenofovir testing-informed counseling could be used to improve virologic suppression (VS) among participants with virologic failure (VF) after ≥1 prior round of enhanced adherence counseling (EAC). METHODS: Participants were enrolled from 42 clinics across Namibia. At each monthly medication pick-up, participants completed the POC urine test and received EAC informed by this testing (EAC+). If VS was not achieved after 3 months of EAC+, up to 3 additional rounds of EAC+ were provided, with resistance testing at month (M)9. RESULTS: Of 310 potentially eligible participants across 42 clinics in Namibia, we enrolled 211 participants with VF (median age 33 years, 61% female); 195 reached M3 defined as receiving EAC+ and follow-up viral load testing; 169 achieved VS within M3 (87%, P < 0001) and 97% by M9 (181/186) compared to 40% (22/55) prior to the intervention (P < 0.001). Resistance testing was performed in five remaining participants with VF at M9, of whom 1/5 (20%) developed dolutegravir resistance. CONCLUSION: The urine tenofovir assay when incorporated into adherence counseling has potential to be a cost-effective intervention among participants failing tenofovir-based regimens, increasing VS to 97% in those failing Tenofovir-Lamivudine-Dolutegravir. Encouraging results of this pre-post intervention will be rigorously tested in a randomized trial.
目的：探讨即时检验（POC）尿替诺福韦检测指导下的咨询能否用于提高在≥1轮强化依从性咨询（EAC）后出现病毒学失败（VF）的参与者的病毒学抑制（VS）情况。 方法：参与者来自纳米比亚的42家诊所。在每月领取药物时，参与者完成POC尿检测，并接受基于该检测结果的EAC（EAC+）。如果在接受EAC+治疗3个月后未实现病毒学抑制，则最多再提供3轮EAC+，并在第9个月（M9）进行耐药性检测。 结果：在纳米比亚42家诊所的310名潜在符合条件的参与者中，我们招募了211名病毒学失败的参与者（中位年龄33岁，61%为女性）；195名参与者达到M3，即接受EAC+并进行后续病毒载量检测；169名参与者在M3内实现了病毒学抑制（87%，P<0.001），到M9时这一比例为97%（181/186），而干预前为40%（22/55）（P<0.001）。在M9时，对其余5名病毒学失败的参与者进行了耐药性检测，其中1/5（20%）出现了多替拉韦耐药。 结论：将尿替诺福韦检测纳入依从性咨询，对于使用基于替诺福韦方案失败的参与者而言，有可能成为一种具有成本效益的干预措施，可使使用替诺福韦-拉米夫定-多替拉韦方案失败的参与者的病毒学抑制率提高至97%。这一干预前后的鼓舞人心的结果将在一项随机试验中进行严格验证。
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