Chamanga Rachel, Musukwa Tessa, Kalitera Louiser, Gent Felix, Nkhoma Harrid, Kudiabor Kwashie, Maida Alice, Kayira Dumbani, Buie Verita, Woelk Godfrey, Maphosa Thulani
Research Department, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Lilongwe, Malawi.
Division of Public Health Service and Implementation Science, U.S. Centers for Disease Control and Prevention (CDC), Blantyre, Malawi.
BMC Public Health. 2024 Dec 30;24(1):3605. doi: 10.1186/s12889-024-21109-0.
In Malawi, compared to adults, adolescents have higher rates of high HIV viremia and poorer antiretroviral therapy (ART) outcomes. The Ministry of Health, supported by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), implemented the provision of differentiated care clubs for adolescents living with HIV (ALHIV), called "teen clubs," to provide psychosocial support and an HIV care package to improve clinical outcomes. We evaluated teen club attendance and factors associated with unsuppressed viral load (VL) in ALHIV enrolled in these teen clubs.
This cross-sectional study used program data from 35 health facilities in four districts that offered teen club services. We enrolled all ALHIV receiving ART ages 10-19 years who attended teen clubs between July 2018- September 2019 and had documented viral load results. Unsuppressed VL was defined as HIV RNA = > 1000 copies/mL, and optimal ART adherence was defined as having an expected pill count suggesting that between 95 and 105% of pills prescribed were consumed. We used multivariable logistic regression to identify factors associated with unsuppressed VL, adjusting for sex, age, education, district, adherence assessment, disclosure of one's HIV status, and teen club attendance.
Our analysis included 1,162 ALHIV with a median age of 15 years (IQR 13-17). The majority were female (n = 614, 53%) and attended one or two teen club visits (n = 665, 57%). Unsuppressed VL was identified in 28% of ALHIV. ALHIV with sub-optimal ART adherence were twice as likely to have unsuppressed VL (adjusted odds ratio [aOR] 2.0, 95% confidence interval (CI): 1.42-2.62) compared to those with optimal ART adherence. ALHIV on second-line treatments, were nearly four times more likely to have unsuppressed VL (aOR 3.7, 95% CI: 1.64-9.09) compared with those on first-line ART. ALHIV who had attained secondary school education were less likely to have unsuppressed VL (aOR 0.42, 95% CI 0.21-0.81) than those who only attained primary school education.
Even amongst adolescents enrolled in teen clubs, teen club attendance is low and high HIV viremia prevails. A continual focus on adolescents is needed to promote consistent teen club attendance and consistent ART adherence among the adolescents enrolled in differentiated service delivery.
在马拉维，与成年人相比，青少年的高HIV病毒血症发生率更高，抗逆转录病毒疗法（ART）效果更差。在伊丽莎白·格拉泽儿童艾滋病基金会（EGPAF）的支持下，卫生部为感染HIV的青少年（ALHIV）实施了提供差异化护理俱乐部的项目，即“青少年俱乐部”，以提供心理社会支持和HIV护理包，改善临床结局。我们评估了参与这些青少年俱乐部的ALHIV的青少年俱乐部出勤情况以及与病毒载量未得到抑制（VL）相关的因素。
这项横断面研究使用了来自四个提供青少年俱乐部服务地区的35个卫生设施的项目数据。我们纳入了所有年龄在10 - 19岁、在2018年7月至2019年9月期间参加青少年俱乐部且有病毒载量记录结果的接受ART治疗的ALHIV。病毒载量未得到抑制被定义为HIV RNA＞1000拷贝/mL，最佳ART依从性被定义为预期的服药计数表明所开处方的95%至105%的药物被服用。我们使用多变量逻辑回归来确定与病毒载量未得到抑制相关的因素，并对性别、年龄、教育程度、地区、依从性评估、HIV感染状况披露以及青少年俱乐部出勤情况进行了调整。
我们的分析纳入了1162名ALHIV，中位年龄为15岁（四分位间距13 - 17岁）。大多数为女性（n = 614，53%），参加过一或两次青少年俱乐部活动（n = 665，57%）。28%的ALHIV病毒载量未得到抑制。与ART依从性最佳的ALHIV相比，ART依从性欠佳的ALHIV病毒载量未得到抑制的可能性是前者的两倍（调整后的优势比[aOR] 2.0，95%置信区间[CI]：1.42 - 2.62）。接受二线治疗的ALHIV病毒载量未得到抑制的可能性几乎是接受一线ART治疗者的四倍（aOR 3.7，95% CI：1.64 - 9.09）。接受过中等教育的ALHIV病毒载量未得到抑制的可能性低于仅接受过小学教育的ALHIV（aOR 0.42，95% CI 0.21 - 0.81）。
即使在参加青少年俱乐部的青少年中，青少年俱乐部的出勤率也较低，高HIV病毒血症普遍存在。需要持续关注青少年，以促进参与差异化服务提供的青少年持续参加青少年俱乐部并坚持ART治疗。
