van der Mannen Jessica S, Furamera Stanford, Pienaar Jacqueline, Komane Pontsho, Shokota Luxolo, Ramashala Boitumelo, Tsope Lindiwe, van der Elst Elise M, Giovenco Danielle, Operario Don, Sanders Eduard J
Implementation Research Division, The Aurum Institute, Johannesburg, South Africa.
Division of Infectious Diseases & Public Health, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
AIDS. 2025 Jul 15;39(9):1290-1296. doi: 10.1097/QAD.0000000000004205. Epub 2025 May 21.
INTRODUCTION: South Africa has the largest HIV epidemic of the world, but predictors of unsuppressed viral load among MSM are scarce. METHODS: We did a cross-sectional study to assess socio-demographic characteristics, year of antiretroviral therapy (ART) initiation, and viral load data from 1385 MSM registered in five key population clinics in five districts in South Africa in 2023 and 2024. We used logistic regression to assess predictors of unsuppressed viral load (≥200 copies/ml). We then conducted a case--control study involving 57 cases (viral load≥200 copies/ml) and 57 matched controls (viral load<200 copies/ml; matched on age, ART start date, clinic, and outreach vs. facility attendance) drawn from the cross-sectional study to explore additional differences between groups. RESULTS: In the cross-sectional study, predictors for unsuppressed viral load included on ART for 1-2 years [odds ratio (OR) 3.53; 1.77-7.69] or 3-5 years (OR 2.33; 1.18-5.04) vs. more than 5 years, being an outreach vs. facility-based client (OR: 2.64; 1.79-3.94), and enrolled at Johannesburg (OR: 3.53; 2.25-5.64), or Durban (OR: 0.36; 0.84-0.70), vs. Pretoria. The case-control study identified predictors for unsuppressed viral load, which included missing more than four ART dosages per month (OR: 5.55; 1.19-41,03), having moderate to severe anxiety (OR: 3.90; 1.34-12,52), hazardous alcohol use (OR: 2.70; 1.14-6.81), and Christian vs. no religion (OR: 3.89; 1.34-12.29). CONCLUSION: We identified regional differences and key predictors of unsuppressed viral load among MSM living with HIV in South Africa. Screening for risk factors for unsuppressed viral load at ART continuation may inform where adherence support and other health services are needed.
引言：南非是全球艾滋病病毒（HIV）疫情最为严重的国家，但男男性行为者（MSM）中病毒载量未得到抑制的预测因素却很匮乏。 方法：我们开展了一项横断面研究，以评估2023年和2024年在南非五个地区的五个重点人群诊所登记的1385名男男性行为者的社会人口学特征、开始抗逆转录病毒治疗（ART）的年份以及病毒载量数据。我们使用逻辑回归分析来评估病毒载量未得到抑制（≥200拷贝/毫升）的预测因素。随后，我们进行了一项病例对照研究，从横断面研究中选取了57例病例（病毒载量≥200拷贝/毫升）和57例匹配对照（病毒载量<200拷贝/毫升；根据年龄、ART开始日期、诊所、外展服务与机构就诊情况进行匹配），以探究两组之间的其他差异。 结果：在横断面研究中，病毒载量未得到抑制的预测因素包括接受ART治疗1 - 2年（比值比[OR] 3.53；1.77 - 7.69）或3 - 5年（OR 2.33；1.18 - 5.04）相较于超过5年，以外展服务对象而非机构就诊者（OR：2.64；1.79 - 3.94），以及在约翰内斯堡登记（OR：3.53；2.25 - 5.64）或德班登记（OR：0.36；0.84 - 0.70）相较于比勒陀利亚。病例对照研究确定了病毒载量未得到抑制的预测因素，包括每月漏服超过四次ART剂量（OR：5.55；1.19 - 41.03）、有中度至重度焦虑（OR：3.90；1.34 - 12.52）、有害饮酒（OR：2.70；1.14 - 6.81）以及基督教徒相较于无宗教信仰者（OR：3.89；1.34 - 12.29）。 结论：我们确定了南非感染HIV的男男性行为者中病毒载量未得到抑制的地区差异和关键预测因素。在ART治疗持续期间筛查病毒载量未得到抑制的风险因素，可能有助于确定需要提供依从性支持和其他健康服务的地点。
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