坦桑尼亚农村地区感染艾滋病毒青少年的病毒抑制情况及依从性

Viral suppression and adherence in adolescents living with HIV in rural Tanzania.

作者信息

Luoga Ezekiel, Okuma James, Moshi Lilian, Sigalla George, Mnzava Dorcas, Paris Daniel H, Glass Tracy R, Vanobberghen Fiona, Weisser Maja, Mollel Getrud Joseph

机构信息

Ifakara Health Institute, Ifakara, Tanzania.

St. Francis Referral Hospital, Ifakara, Tanzania.

出版信息

PLoS One. 2024 Dec 20;19(12):e0315866. doi: 10.1371/journal.pone.0315866. eCollection 2024.

DOI:10.1371/journal.pone.0315866

PMID:39705296

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11661625/

Abstract

BACKGROUND

Adolescents living with HIV (ALHIV) in sub-Saharan Africa are affected by poor treatment outcomes, likely a consequence of poor adherence.

OBJECTIVES

To assess viral suppression rates and evaluate factors associated with achieving viral suppression and maintaining treatment adherence among ALHIV in rural Tanzania.

METHODS

Cross-sectional analysis of data from the Kilombero and Ulanga Antiretroviral Cohort in Ifakara, Tanzania, including adolescents aged 10-19 years on antiretroviral treatment (ART) ≥6 months at the time point of their first viral load (VL) measurement after implementation of routine VL testing from August 2017 through December 2023. VL ≥1000 copies/ml was considered unsuppressed. We assessed agreement between adherence measures (self-report, pill box return, pill count and visual analogy scale) and viral suppression. Logistic regression was used to determine factors associated with viral suppression.

RESULTS

Of 319 included adolescents, 159 (50%) were male, 143 (45%) aged 10-13 years, 213 (74%) had disclosed their HIV status, 72 (23%) lived ≥50 kilometers from the clinic, 161 (55%) had a WHO stage III/IV and 80 (33%) had CD4 cell counts <500 cells/mm3. Overall, 249 (78%) adolescents were virally suppressed. Factors associated with viral suppression were having a CD4 cell count ≥500 cells/mm3 (adjusted Odds Ratio (aOR) 3.48; 95% CI 1.49-8.13) versus those with a CD4 cell count <500 cells/mm3, being on a dolutegravir-based regimen (aOR 12.6; 95% CI 2.50-68.7) versus those on a NNRTI based regimen. Female gender was associated with lower odds of having viral suppression (aOR 0.41; 95%CI 0.18-0.93). There was a weak to moderate agreement between adherence measures and VL suppression.

CONCLUSION

Adolescents in this rural cohort remain far behind the UNAIDS 95% viral suppression target with only 78% being virally suppressed. The weak to moderate associations between adherence assessment and viral suppression. Adolescents' HIV care models need to be strengthened in order to achieve viral suppression goals in this population.

摘要

背景

撒哈拉以南非洲地区的青少年艾滋病毒感染者（ALHIV）治疗效果不佳，这可能是依从性差的结果。

目的

评估坦桑尼亚农村地区ALHIV的病毒抑制率，并评估与实现病毒抑制和维持治疗依从性相关的因素。

方法

对坦桑尼亚伊法卡拉的基洛梅罗和乌朗加抗逆转录病毒队列数据进行横断面分析，包括2017年8月至2023年12月实施常规病毒载量（VL）检测后首次进行VL测量时接受抗逆转录病毒治疗（ART）≥6个月的10 - 19岁青少年。VL≥1000拷贝/毫升被视为未被抑制。我们评估了依从性测量方法（自我报告、药盒返还、药丸计数和视觉模拟量表）与病毒抑制之间的一致性。采用逻辑回归确定与病毒抑制相关的因素。

结果

在纳入的319名青少年中，159名（50%）为男性，143名（45%）年龄在10 - 13岁，213名（74%）已披露其艾滋病毒感染状况，72名（23%）居住在距离诊所≥50公里处，161名（55%）处于世界卫生组织III/IV期，80名（33%）CD4细胞计数<500个细胞/立方毫米。总体而言，249名（78%）青少年实现了病毒抑制。与病毒抑制相关的因素包括CD4细胞计数≥500个细胞/立方毫米（调整后的优势比（aOR）3.48；95%置信区间1.49 - 8.13）相较于CD4细胞计数<500个细胞/立方毫米的青少年，接受基于多替拉韦的治疗方案（aOR 12.6；95%置信区间；2.50 - 68.7）相较于接受基于非核苷类逆转录酶抑制剂（NNRTI）的治疗方案。女性实现病毒抑制的几率较低（aOR 0.4；95%置信区间0.18 - 0.93）。依从性测量方法与VL抑制之间存在弱至中度的一致性。