Rugemalila Joan, Minja Anna, Somba Magreat, Sariah Adellah, Siril Hellen, Sudfeld Christopher, Nagu Tumaini, Sunguya Bruno, Aboud Said
Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania.
PLoS One. 2025 Jun 25;20(6):e0320272. doi: 10.1371/journal.pone.0320272. eCollection 2025.
Virologic response is the earliest indicator of HIV treatment, making it the gold standard in monitoring treatment response. This study explored experiences and challenges of HIV treatment and viral load (HVL) monitoring among adolescents and young adults (AYA), parents or guardians of young adolescents and healthcare providers (HCPs).
This was a qualitative study conducted between March and May 2022 in five health facilities in an urban setting of Tanzania. We performed 20 in-depth interviews (IDIs) with AYA who had full HIV-positive status disclosure, 8 IDIs with parents or guardians of young HIV-infected adolescents, and five focus group discussions (FGDs) with 30 HCPs. The IDIs and FGD transcripts were translated from Swahili into English, transcribed, coded, and performed thematic analysis using NVivo software.
AYA demonstrated an understanding of HIV treatment as lifelong and, most knew the benefits of HIV viral load (HVL) monitoring. It was apparent that 60% of older adolescents (15-19 years), parents or guardians, and young adults (20-24 years) discussed HVL results with HCPs and, the majority desire to be involved in their HIV treatment. HCPs reported that missing clinic appointments among AYA attending boarding schools or college contribute to delays in HVL testing and initiation of enhanced adherence counselling (EAC). Notably, HCP faced challenges recalling AYA who received three to six multi-month anti-retroviral drug (ARV) refills when their HVL results were high (VL ≥ 1000 copies/ml).
More than half of AYA expressed ownership in their HIV treatment; they discussed the meaning of their HVL results with HCPs. Additionally, AYA reported non-frequent challenges in HVL testing however, HCPs described missing appointments for AYA on three to six multi-months dispensing of ARVs as major challenges for implementing HVL testing. Importantly multi-months ARV dispensing in AYA needs program evaluation to inform the best implementation modality to support viral suppression.
病毒学反应是艾滋病治疗的最早指标，使其成为监测治疗反应的金标准。本研究探讨了青少年和青年（AYA）、青少年父母或监护人以及医疗服务提供者（HCP）在艾滋病治疗和病毒载量（HVL）监测方面的经验和挑战。
这是一项于2022年3月至5月在坦桑尼亚城市地区的五个卫生机构进行的定性研究。我们对已完全披露艾滋病病毒阳性状态的AYA进行了20次深入访谈（IDI），对感染艾滋病病毒的青少年的父母或监护人进行了8次IDI，并与30名HCP进行了5次焦点小组讨论（FGD）。IDI和FGD的文字记录从斯瓦希里语翻译成英语，进行转录、编码，并使用NVivo软件进行主题分析。
AYA理解艾滋病治疗是终身的，并且大多数人知道艾滋病病毒载量（HVL）监测的益处。显然，60%的年龄较大的青少年（15 - 19岁）、父母或监护人以及青年（20 - 24岁）与HCP讨论了HVL结果，并且大多数人希望参与自己的艾滋病治疗。HCP报告称，就读寄宿学校或大学的AYA错过门诊预约导致HVL检测延迟以及强化依从性咨询（EAC）的启动延迟。值得注意的是，当HVL结果较高（病毒载量≥1000拷贝/毫升）时，HCP在召回接受三到六个月抗逆转录病毒药物（ARV）补充剂的AYA方面面临挑战。
超过一半的AYA在其艾滋病治疗中表达了自主权；他们与HCP讨论了自己HVL结果的意义。此外，AYA报告在HVL检测中遇到的挑战并不频繁，然而，HCP将AYA在三到六个月的ARV配药期间错过预约描述为实施HVL检测的主要挑战。重要的是，针对AYA的多月份ARV配药需要进行项目评估，以确定支持病毒抑制的最佳实施方式。
