Balogun Mobolanle, Kuhns Lisa M, Akanmu Alani S, Garofalo Robert, Badru Titilope, Adekanmbi Abiodun F, Akinbami Akinsegun, Agbaji Oche, David Agatha N, Omigbodun Olayinka, Cevantes Marbella, Janulis Patrick, Akintan Patricia, Awolude Olutosin, Kuti Kehinde M, Sodipo Oluwajimi, Yiltok Esther, Mautin Gbenayon J, Ezemelue Priscilla, Berzins Baiba, Taiwo Babafemi
Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria.
Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
AIDS Behav. 2025 Mar;29(3):848-857. doi: 10.1007/s10461-024-04565-y. Epub 2024 Dec 9.
Viral suppression with antiretroviral therapy (ART) is a critical component of UNAIDS objectives to end the HIV epidemic. Youth living with HIV (YLH) have worse viral suppression rates than adults. The aim of this study was to identify risk factors for viral non-suppression among YLH in Nigeria. A secondary analysis of enrollment data from the iCARE Nigeria study, collected April-October 2021 for 541 YLH comprised demographic, psychosocial, behavioral, clinical variables, and viral load quantification. Viral non-suppression was defined as viral load ≥ 200 copies/mL. Generalized linear models using Akaike information criterion for selection of indicator variables in a stepwise approach were used to determine the risk factors for viral non-suppression. The final analytic sample was 491 and the proportion of non-suppressed participants at baseline was 40%. In the final model, substance use (other than alcohol, tobacco and/or cannabis) (aOR = 3.20 [95% CI: 1.05, 10.34]), missed medication doses (aOR = 1.09 [95% CI: 1.04, 1.15]), and a higher number of self-reported medication barriers (e.g., forgot, busy, change in routine) (aOR = 1.08 [95% CI: 1.00, 1.16]) were associated with a higher likelihood of viral non-suppression. Being prescribed a first-line regimen (aOR = 0.28 [95% CI: 0.17, 0.44]), disclosure to at least one brother (aOR = 0.64 [95% CI: 0.42, 0.97]), and higher treatment outcome expectancies (e.g., taking medication will improve health) (aOR = 0.81 [95% CI: 0.66, 0.98]), were all associated with a lower likelihood of viral non-suppression. Viral non-suppression among YLH in Nigeria is associated with psychosocial and behavioral factors, including missed doses, medication barriers, treatment outcome expectancies, and disclosure, that are potential targets for intervention to achieve ART goals.
通过抗逆转录病毒疗法（ART）实现病毒抑制是联合国艾滋病规划署终结艾滋病流行目标的关键组成部分。感染艾滋病毒的青年（YLH）的病毒抑制率比成年人更差。本研究的目的是确定尼日利亚感染艾滋病毒青年中病毒未抑制的风险因素。对2021年4月至10月收集的尼日利亚iCARE研究的入组数据进行二次分析，该数据涉及541名感染艾滋病毒青年，包括人口统计学、心理社会、行为、临床变量以及病毒载量定量。病毒未抑制定义为病毒载量≥200拷贝/毫升。使用赤池信息准则在逐步方法中选择指标变量的广义线性模型用于确定病毒未抑制的风险因素。最终分析样本为491例，基线时未抑制参与者的比例为40%。在最终模型中，使用（除酒精、烟草和/或大麻以外的）物质（调整后比值比[aOR]=3.20[95%置信区间：1.05，10.34]）、漏服药物剂量（aOR=1.09[95%置信区间：1.04，1.15]）以及自我报告的药物障碍数量较多（例如，忘记、忙碌、日常安排改变）（aOR=1.08[95%置信区间：1.00，1.16]）与病毒未抑制的可能性较高相关。被开具一线治疗方案（aOR=0.28[95%置信区间：0.17，0.44]）、向至少一个兄弟透露病情（aOR=0.64[95%置信区间：0.42，0.97]）以及更高的治疗结果期望（例如，服药将改善健康）（aOR=0.81[95%置信区间：0.66，0.98]）均与病毒未抑制的可能性较低相关。尼日利亚感染艾滋病毒青年中的病毒未抑制与心理社会和行为因素相关，包括漏服剂量、药物障碍、治疗结果期望和透露病情，这些都是实现抗逆转录病毒疗法目标的潜在干预靶点。
