Use of viral load to improve survey estimates of known HIV-positive status and antiretroviral treatment coverage.
Use of viral load to improve survey estimates of known HIV-positive status and antiretroviral treatment coverage.
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DOI：
10.1097/qad.0000000000002453
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发表时间：
2020-03-15
期刊：
影响因子：
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通讯作者：
De Cock KM
中科院分区：
文献类型：
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作者：
Young PW;Zielinski-Gutierrez E;Wamicwe J;Mukui I;Kim AA;Waruru A;Zeh C;Kretzschmar ME;De Cock KM
比较基于血液中不可检测的病毒载量 (UVL) 和 ARV 检测来调整自我报告的 HIV 阳性状况知识和抗逆转录病毒 (ARV) 治疗使用的替代方法。对全国代表性家庭调查进行事后分析，以比较对人口艾滋病毒指标的基于替代生物标记的调整。如果在 2012 年肯尼亚艾滋病指标调查 (KAIS) 中检测到抗逆转录病毒药物或在干血点上检测不到病毒载量（<550 拷贝/mL），我们将自我报告中不知道自己艾滋病毒阳性状况的 15-64 岁艾滋病毒阳性参与者重新分类为知晓并接受抗逆转录病毒治疗。我们将自我报告与 ARV 测量、UVL 或两者的调整进行了比较。所有 HIV 阳性受访者的治疗覆盖率从仅基于 ARV 检测的自我报告的 31.8% 增加到 42.5% [95% CI 37.4–47.8]，在 ARV 调整后增加到 42.8% (95% CI 37.9–47.8)，在 UVL 调整和 UVL 调整后增加到 46.2% (95% CI 41.3–51.1)。当针对 ARV 或 UVL 进行调整时，为 48.8% (95% CI 43.9–53.8)。阳性状态的认知度从自我报告的 46.9% 增加到经 ARV 调整后的 56.2% (95% CI 50.7–61.6)、经 UVL 调整后的 57.5% (95% CI 51.9–63.0) 和经 ARV 或 UVL 调整后的 59.8% (95% CI 54.2–65.1)。调查中常规测量的无法检测到的病毒载量可能是抗逆转录病毒检测的有用辅助或替代方案，用于调整艾滋病毒状况知识和抗逆转录病毒治疗覆盖率的调查估计。
To compare alternative methods of adjusting self-reported knowledge of HIV-positive status and antiretroviral (ARV) therapy use based on undetectable viral load (UVL) and ARV detection in blood. Post hoc analysis of nationally-representative household survey to compare alternative biomarker-based adjustments to population HIV indicators. We reclassified HIV-positive participants aged 15–64 years in the 2012 Kenya AIDS Indicator Survey (KAIS) that were unaware of their HIV-positive status by self-report as aware and on antiretroviral treatment if either ARVs were detected or viral load was undetectable (<550 copies/mL) on dried blood spots. We compared self-report to adjustments for ARVs measurement, UVL, or both. Treatment coverage among all HIV-positive respondents increased from 31.8% for self-report to 42.5% [95% confidence interval (CI) 37.4–47.8] based on ARV detection alone, to 42.8% (95% CI 37.9–47.8) when ARV-adjusted, 46.2% (95% CI 41.3–51.1) when UVL-adjusted and 48.8% (95% CI 43.9–53.8) when adjusted for either ARV or UVL. Awareness of positive status increased from 46.9% for self-report to 56.2% (95% CI 50.7–61.6) when ARV-adjusted, 57.5% (95% CI 51.9–63.0) when UVL-adjusted, and 59.8% (95% CI 54.2–65.1) when adjusted for either ARV or UVL. Undetectable viral load, which is routinely measured in surveys, may be a useful adjunct or alternative to ARV detection for adjusting survey estimates of knowledge of HIV status and antiretroviral treatment coverage.