Low HIV viral suppression rates following the intensive adherence counseling (IAC) program for children and adolescents with viral failure in public health facilities in Uganda.
Low HIV viral suppression rates following the intensive adherence counseling (IAC) program for children and adolescents with viral failure in public health facilities in Uganda.
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DOI：
10.1186/s12889-018-5964-x
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发表时间：
2018-08-22
影响因子：
4.5
通讯作者：
Nakanjako D
中科院分区：
文献类型：
--
作者：
Nasuuna E;Kigozi J;Babirye L;Muganzi A;Sewankambo NK;Nakanjako D
联合国艾滋病规划署的90-90-90战略明确规定，所有接受抗逆转录病毒治疗(ART)的人中，90%的人应该具有抑制的病毒载量。世卫组织最近建议加强依从性咨询，以改善接受抗逆转录病毒治疗的儿童和青少年病毒学失败患者的病毒抑制。本文描述了IAC在公共艺术项目实施的第一年的实施情况和结果，以提供战略干预措施，以达到儿童的第三个90岁。从2015年6月至2016年12月，对15家公共卫生机构所有9个月至19个月的艾滋病毒病毒载量(VL) ≥ 为1000拷贝/毫升的儿童进行了回顾性图表审查。提取和分析初始VL试验结果、IAC会话、重复VL试验结果和ART方案转换的数据，以完成IAC和IAC后的病毒抑制。总共有449名儿童的可检测到的病毒载量超过1000拷贝/毫升，经过平均3.5年(SD 5.8)的抗逆转录病毒治疗。192名(43%)年龄在10-20岁之间，320名(71%)接受以奈维拉平为基础的ART方案。在完成了推荐的三次IAC疗程的345名(77%)患者中，62名(23%)在IAC治疗后实现了病毒抑制。第1次至第3次IAC会议的平均时间为113天(SD 153)，172名儿童(50%)在200天内完成了3次会议。在完成推荐的三次IAC疗程的病毒学失败的接受ART治疗的儿童中，抑制率很低。随着我们朝着让90%接受抗逆转录病毒治疗的儿童和青少年实现并保持病毒抑制的目标迈进，有必要重新评估在儿童和青少年中实施IAC的情况，以考虑心理社会和生物因素，例如对那些具有多个可检测到的病毒载量的人进行耐药性测试。
The UNAIDS 90–90-90 strategy clearly stipulates that 90% of all people on antiretroviral therapy (ART) should have a suppressed viral load. Intensified adherence counselling (IAC) was recently recommended by WHO to improve viral suppression among ART-treated paediatric and adolescent clients with virological failure. This paper describes the implementation and outcomes of IAC in the first year of implementation in a public ART program, to inform strategic interventions to reach the “third 90” among children. A retrospective chart review was conducted for all children aged 9 months to 19 years with HIV viral loads (VL) ≥ 1000 copies/ml at 15 public health facilities from June 2015–December 2016. Data on initial VL test results, IAC sessions, repeat VL test results, and ART regimen switch were abstracted and analysed for completion of IAC and viral suppression after IAC. A total of 449 children had a detectable viral load above 1000 copies/ml, after an average of 3.5 years (SD 5.8) years of ART. 192 (43%) were 10–20 years of age, and 320 (71%) were receiving Nevirapine-based ART regimen. Out of 345 (77%) who completed the recommended three IAC sessions, 62 (23%) achieved viral suppression following IAC. The mean time from 1st to 3rd IAC session was 113 (SD 153) days and 172 (50%) of the children had completed the three sessions within 200 days. Suppression rates were low among ART-treated children with virological failure that completed the recommended three IAC sessions. As we move towards having 90% of ART-treated children and adolescents achieve and maintain viral suppression, there is need to re-evaluate the implementation of IAC among children and adolescents to consider both psychosocial and biological factors such as resistance testing for those with multiple detectable viral loads.
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DOI：
10.1097/qai.0000000000000224
发表时间：
2014-09-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Jobanputra K;Parker LA;Azih C;Okello V;Maphalala G;Jouquet G;Kerschberger B;Mekeidje C;Cyr J;Mafikudze A;Han W;Lujan J;Teck R;Antierens A;van Griensven J;Reid T
通讯作者：
Reid T
影响因子：
2.4
作者：
Eticha T;Berhane L
通讯作者：
Berhane L
DOI：
10.1097/qai.0b013e31814278c0
发表时间：
2007-10-01
影响因子：
3.6
作者：
Kamya, Moses R.;Mayanja-Kizza, Harriet;Kekitiinwa, Adeodata
通讯作者：
Kekitiinwa, Adeodata
影响因子：
4.4
作者：
Byakika-Tusiime, Jayne;Crane, Johanna;Bangsberg, David R.
通讯作者：
Bangsberg, David R.
影响因子：
4.4
作者：
Bikaako-Kajura, Winnie;Luyirika, Emmanuel;Bunnell, Rebecca
通讯作者：
Bunnell, Rebecca