Effectiveness of intensive adherence counselling in achieving an undetectable viral load among people on antiretroviral therapy with low-level viraemia in Uganda.
Effectiveness of intensive adherence counselling in achieving an undetectable viral load among people on antiretroviral therapy with low-level viraemia in Uganda.
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在乌干达接受抗逆转录病毒治疗的低水平病毒血症人群中，强化依从性咨询对于实现不可检测的病毒载量的有效性。
DOI：
10.1111/hiv.13568
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发表时间：
2024
期刊：
影响因子：
3
通讯作者：
Kiwanuka,Noah
中科院分区：
文献类型：
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作者：
Nanyeenya,Nicholus;Nakanjako,Damalie;Makumbi,Fredrick;Nakigozi,Gertrude;Nalugoda,Fred;Kigozi,Godfrey;Nasuuna,Esther;Kibira,SimonPS;Nabadda,Susan;Kiyaga,Charles;Huzaifah,Mutyaba;Kiwanuka,Noah
在这项研究之前，乌干达正在使用1000拷贝/mL的阈值来确定艾滋病毒感染者抗逆转录病毒治疗监测中的病毒非抑制。目前尚不清楚低水平病毒血症（LLV，≥50至<1000拷贝/mL）的HIV感染者是否会从强化依从性咨询（IAC）中受益。本研究的目的是确定IAC在乌干达接受抗逆转录病毒治疗的艾滋病毒感染者和LLV患者中的有效性，以指导艾滋病毒护理的关键政策决策，包括审查病毒载量（VL）测试算法。该整群随机临床试验包括来自8个HIV诊所的成年人，他们感染了HIV，接受了ART治疗，并且最近的VL结果表明LLV（从2022年7月到2022年10月检测）。干预组诊所的参与者接受三次每月一次的IAC治疗，而非干预组诊所的参与者接受标准治疗。在研究结束时，对所有参与者重新进行VL测试，以确定无法检测到VL的比例（<50拷贝/mL）。我们使用Fisher精确检验评估了交叉表变量之间的统计相关性，然后修改了泊松回归。结果共有136名参与者参加了8家HIV诊所的研究。干预组的所有68名参与者都完成了所有IAC会议。在非干预组中，只有一名参与者没有随访。干预组和非干预组的平均随访时间分别为3.7个月（标准差[SD] 0.2）和3.5个月（标准差[SD] 0.1）。在研究随访期间，135名HIV感染者中有59人（43.7%）达到了无法检测到的VL。IAC对LLV患者达到无法检测的VL的影响在干预组（57.4%）几乎是非干预组（29.9%）的两倍：调整风险比为1.9(95%置信区间1.0-3.5),p= 0.037。结论iac使伴有LLV的HIV感染者发生无法检测到的VL的可能性增加了一倍。因此，IAC已被制定为一种干预措施，以管理乌干达的艾滋病毒感染者和LLV，这也应该在其他具有类似环境的撒哈拉以南非洲国家采用。
IntroductionUganda was using a threshold of 1000 copies/mL to determine viral non‐suppression for antiretroviral therapy monitoring among people living with HIV, prior to this study. It was not clear whether people living with HIV with low‐level viraemia (LLV, ≥50 to <1000 copies/mL) would benefit from intensive adherence counselling (IAC). The purpose of this study was to determine the effectiveness of IAC among people living with HIV, receiving antiretroviral therapy, and with LLV in Uganda, to guide key policy decisions in HIV care, including the review of the viral load (VL) testing algorithm.MethodsThis cluster‐randomized clinical trial comprised adults from eight HIV clinics who were living with HIV, receiving ART, and had recent VL results indicating LLV (tested from July 2022 to October 2022). Participants in the intervention arm clinics received three once‐monthly sessions of IAC, and those in the comparison non‐intervention arm clinics received the standard of care. At the end of the study, all participants were re‐tested for VL to determine the proportions of those who then had an undetectable VL (<50 copies/mL). We assessed the statistical association between cross‐tabulated variables using Fisher's exact test and then modified Poisson regression.ResultsA total of 136 participants were enrolled into the study at eight HIV clinics. All 68 participants in the intervention arm completed all IAC sessions. Only one participant in the non‐intervention arm was lost to follow‐up. The average follow‐up time was 3.7 months (standard deviation [SD] 0.2) and 3.5 months (SD 0.1) in the intervention and non‐intervention arms, respectively.In total, 59 (43.7%) of 135 people living with HIV achieved an undetectable VL during the study follow‐up period. The effect of IAC on attaining an undetectable VL among people with LLV was nearly twice as high in the intervention arm (57.4%) than in the non‐intervention arm (29.9%): adjusted risk ratio 1.9 (95% confidence interval 1.0–3.5),p= 0.037.ConclusionIAC doubled the likelihood of an undetectable VL among people living with HIV with LLV. Therefore, IAC has been instituted as an intervention to manage people living with HIV with LLV in Uganda, and this should also be adopted in other Sub‐Saharan African countries with similar settings.ClinicalTrials.Gov IdentifierNCT05514418.