Adaptive Viral Load Monitoring Frequency to Facilitate Differentiated Care: A Modeling Study From Rakai, Uganda.
Adaptive Viral Load Monitoring Frequency to Facilitate Differentiated Care: A Modeling Study From Rakai, Uganda.
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自适应病毒载量监测频率以促进差异化护理：乌干达拉凯的一项建模研究。
DOI：
10.1093/cid/ciz880
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Reynolds,StevenJ
中科院分区：
文献类型：
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作者：
Ssempijja,Victor;Nason,Martha;Nakigozi,Gertrude;Ndyanabo,Anthony;Gray,Ron;Wawer,Maria;Chang,LarryW;Gabriel,Erin;Quinn,ThomasC;Serwadda,David;Reynolds,StevenJ
在抗逆转录病毒治疗（ART）规模扩大后，大多数国家已采用常规的年度病毒载量监测，但在资源有限的情况下，减少病毒载量监测的频率可能会节省成本。我们调查，如果病毒载量监测频率可以减少，同时保持检测治疗failure.MethodsThe Rakai健康科学计划进行常规，每年两次的病毒载量监测2489人与人类免疫缺陷病毒（年龄≥15岁）。在这些数据的基础上，我们建立了一个两阶段的模拟模型，比较不同的病毒载量监测方案。我们拟合了病毒载量>1000拷贝/mL的时间的Weibull回归模型（治疗失败），和模拟数据的10 000个人超过5年，比较5个监测方案，目前的病毒载量检测每6个月和每12个月。对所有受试者每6个月监测一次，未检测到的失败的月数最少，但病毒载量测试的次数也最多。适应性方案使用以前的病毒载量测量，以通知未来的监测显着减少了病毒载量测试的数量，而没有显着增加未被发现的失败的月数。最佳的自适应监测方案导致病毒载量测量减少67%，而未检测到的失败的月数增加<20%.ConclusionsAdaptive病毒载量监测的基础上，以前的病毒载量测量可能是最佳的维持病人的护理，同时降低成本，让更多的病人得到治疗和监测。未来的实证研究，以评估有区别的监测是必要的。
BackgroundAfter scale-up of antiretroviral therapy (ART), routine annual viral load monitoring has been adopted by most countries, but reduced frequency of viral load monitoring may offer cost savings in resource-limited settings. We investigated if viral load monitoring frequency could be reduced while maintaining detection of treatment failure.MethodsThe Rakai Health Sciences Program performed routine, biannual viral load monitoring on 2489 people living with human immunodeficiency virus (age ≥15 years). On the basis of these data, we built a 2-stage simulation model to compare different viral load monitoring schemes. We fit Weibull regression models for time to viral load >1000 copies/mL (treatment failure), and simulated data for 10 000 individuals over 5 years to compare 5 monitoring schemes to the current viral load testing every 6 months and every 12 months.ResultsAmong 7 monitoring schemes tested, monitoring every 6 months for all subjects had the fewest months of undetected failure but also had the highest number of viral load tests. Adaptive schemes using previous viral load measurements to inform future monitoring significantly decreased the number of viral load tests without markedly increasing the number of months of undetected failure. The best adaptive monitoring scheme resulted in a 67% reduction in viral load measurements, while increasing the months of undetected failure by <20%.ConclusionsAdaptive viral load monitoring based on previous viral load measurements may be optimal for maintaining patient care while reducing costs, allowing more patients to be treated and monitored. Future empirical studies to evaluate differentiated monitoring are warranted.