Moholola Molebatsi, Rees Kate, Motsoane Nthabiseng, Kgopong Ntsetse, Mutyambizi Chipo
Anova Health Institute, Capricorn, South Africa.
Department of Community Health, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
PLoS One. 2025 Jan 6;20(1):e0317015. doi: 10.1371/journal.pone.0317015. eCollection 2025.
Case management is a structured, client centered approach that incorporates various strategies such as employing lay counsellors to provide psychosocial and adherence support to strengthen antiretroviral (ART) adherence, improve retention in care and viral load (VL) suppression. This study aimed to evaluate the effects of case management on VL in clients enrolled due to non-suppression (> = 50 copies/ml) in Capricorn District, Limpopo Province.
We conducted a case control study using two datasets (1) cases were selected from case management data collected from June 2021 to November 2022 at 35 facilities and captured on the REDCap system. (2) controls were identified from TIER.Net data from facilities where case management is not available and with at least two VLs on record since June 2021. Our study was restricted to clients with an unsuppressed (> = 50 copies) VL at enrollment, over the age of 18 years and excluded clients with a missing VL at enrollment. Using similar age, gender, and VL characteristics, an equal number of clients not receiving case management was randomly sampled from the TIER.Net data. Descriptive and multivariate logistic regression analysis were used to determine the factors associated with viral suppression.
Our final study sample consisted of 3 256 clients, half of which received case management (N = 1 628), 1084 (33%) with a first VL in study of 50-399 copies/ml, 404 (12%) 400-999 copies/ml and 1768 (54%) >1000 copies/ml. Post case management intervention results showed that 49% had a VL below 50 copies/ml amongst those receiving case management and 44% among those who did not receive case management. In the adjusted model we found that case management (Odds ratio [OR] 1.25; 95% Confidence Interval [CI] 1.08-1.44) versus no case management, 35-54 years old (1.43; 1.07-1.91) and 55+ year old (1.88; 1.35-2.61) versus 18-24-year-old increased odds of VL suppression whilst being male (0.72; 0.61-0.84) versus being female has decreased odd of VL suppression.
Close to half of the clients had a VL below 50 copies/ml after case management. Factors that increased the odds of VL suppression were case management and older age, whilst being male was associated with reduced odds of VL suppression. Differentiated services for virally unsuppressed clients would be helpful for men. Case management was associated with viral suppression in those with a starting VL > 1000 copies/ml and not for those starting with low level viremia (50-999 copies/ml).
病例管理是一种结构化的、以患者为中心的方法，它采用多种策略，如雇佣非专业顾问提供心理社会支持和依从性支持，以加强抗逆转录病毒治疗（ART）的依从性，提高治疗留存率并抑制病毒载量（VL）。本研究旨在评估病例管理对林波波省摩羯区因病毒载量未被抑制（>=50拷贝/毫升）而登记入组的患者的病毒载量的影响。
我们进行了一项病例对照研究，使用了两个数据集：（1）病例选自2021年6月至2022年11月在35个机构收集并录入REDCap系统的病例管理数据。（2）对照从TIER.Net数据中确定，这些数据来自没有病例管理服务且自2021年6月以来至少有两次病毒载量记录的机构。我们的研究仅限于入组时病毒载量未被抑制（>=50拷贝）、年龄超过18岁且排除入组时病毒载量缺失的患者。根据年龄、性别和病毒载量特征相似的原则，从TIER.Net数据中随机抽取数量相等的未接受病例管理的患者。采用描述性和多变量逻辑回归分析来确定与病毒抑制相关的因素。
我们最终的研究样本包括3256名患者，其中一半接受了病例管理（N = 1628），1084名（33%）在研究中的首次病毒载量为50 - 399拷贝/毫升，404名（12%）为400 - 999拷贝/毫升，1768名（54%）>1000拷贝/毫升。病例管理干预后的结果显示，接受病例管理的患者中有49%的病毒载量低于50拷贝/毫升，未接受病例管理的患者中这一比例为44%。在调整模型中，我们发现与未接受病例管理相比，病例管理（优势比[OR] 1.25；95%置信区间[CI] 1.08 - 1.44）、35 - 54岁（1.43；1.07 - 1.91）和55岁及以上（1.88；1.35 - 2.61）与18 - 24岁相比，病毒载量抑制的几率增加，而男性（0.72；0.61 - 0.84）与女性相比，病毒载量抑制的几率降低。
病例管理后，近一半的患者病毒载量低于50拷贝/毫升。增加病毒载量抑制几率的因素是病例管理和年龄较大，而男性与病毒载量抑制几率降低有关。为病毒未被抑制的男性患者提供差异化服务将有所帮助。病例管理与起始病毒载量>1000拷贝/毫升的患者的病毒抑制相关，而与起始低水平病毒血症（50 - 999拷贝/毫升）的患者无关。
