Clinical outcomes after first-line HIV treatment failure in South Africa: the next cascade of care
Clinical outcomes after first-line HIV treatment failure in South Africa: the next cascade of care
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DOI：
10.1111/hiv.12877
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发表时间：
2020-06-03
期刊：
影响因子：
3
通讯作者：
Baisley, K.
中科院分区：
文献类型：
--
作者：
Iwuji, C. C.;Shahmanesh, M.;Baisley, K.
引言有关于病毒载量（VL）的监测和可检测的VL在公共卫生环境中的管理在农村SouthAfrica.Methods的适当性的文献有限，我们分析了从艾滋病毒阳性患者的电子患者登记册中捕获的数据>= 15岁开始抗逆转录病毒治疗（ART）在农村夸祖鲁-纳塔尔，在2010-2016年期间的17个公共部门诊所。我们估计VL监测在6、12和24个月时的完成率。我们描述了在ART治疗>= 20周后，任何VL测量值>= 1000 HIV-1 RNA拷贝/mL的患者的护理级联，包括以下比例：（1）6个月内重复VL;（2）再次抑制;（3）转为二线治疗。结果29384人在此期间开始ART治疗[69%为女性，中位年龄31岁（四分位数间距25-39）]。在6个月、12个月和24个月时接受治疗的患者中，分别有40.7%（9861/24 199）、34%（7765/22 807）和25.5%（4334/16 965）在每个推荐时间点进行了VL检测。分别有12%（2730/22 807）和6.2%（1054/16 965）的ART治疗患者在所有推荐时间点记录了12个月和24个月的VL结果。在2135名接受一线抗逆转录病毒治疗的VL >= 1000拷贝/mL的患者中，只有391人（18.3%）重复VL记录了再抑制或适当地改为二线治疗，但持续失败。完成治疗失败级联发生的中位数为338天失败后detected.Conclusion我们发现次优VL监测和不良反应的病毒学失败的公共部门ART诊所在南阿里卡农村。其影响包括耐药艾滋病毒的发病率和传播的可能性增加。
Introduction There is limited literature on the appropriateness of viral load (VL) monitoring and management of detectable VL in public health settings in rural South Africa.Methods We analysed data captured in the electronic patient register from HIV-positive patients >= 15 years old initiating antiretroviral therapy (ART) in 17 public sector clinics in rural KwaZulu-Natal, during 2010-2016. We estimated the completion rate for VL monitoring at 6, 12, and 24 months. We described the cascade of care for those with any VL measurement >= 1000 HIV-1 RNA copies/mL after >= 20 weeks on ART, including the following proportions: (1) repeat VL within 6 months; (2) re-suppressed; (3) switched to second-line regimen.Results There were 29 384 individuals who initiated ART during the period [69% female, median age 31 years (interquartile range 25-39)]. Of those in care at 6, 12, and 24 months, 40.7% (9861/24 199), 34% (7765/22 807), and 25.5% (4334/16 965) had a VL test at each recommended time-point, respectively. The VL results were documented at all recommended time-points for 12% (2730/22 807) and 6.2% (1054/16 965) of ART-treated patients for 12 and 24 months, respectively. Only 391 (18.3%) of 2135 individuals with VL >= 1000 copies/mL on first-line ART had a repeat VL documenting re-suppression or were appropriately changed to second-line with persistent failure. Completion of the treatment failure cascade occurred a median of 338 days after failure was detected.Conclusion We found suboptimal VL monitoring and poor responses to virologic failure in public-sector ART clinics in rural South Arica. Implications include increased likelihood of morbidity and transmission of drug-resistant HIV.