Impact and programmatic implications of routine viral load monitoring in Swaziland.
Impact and programmatic implications of routine viral load monitoring in Swaziland.
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DOI：
10.1097/qai.0000000000000224
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发表时间：
2014-09-01
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影响因子：
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通讯作者：
Reid T
中科院分区：
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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
文本中提供了补充数字内容。评估斯威士兰常规病毒载量 (VL) 监测的计划质量（检测、咨询和重新检测的覆盖范围）、成本和结果（病毒抑制、治疗决策）。对斯威士兰接受常规VL监测的患者进行的回顾性队列研究（2012年10月1日至2013年3月31日）。研究期间有 5563 名符合常规 VL 检测监测条件的患者中，估计当年有 4767 名患者 (86%) 接受了检测。在 288 名可检测 VL 的患者中，210 名 (73%) 接受了强化依从性咨询，202 名 (70%) 在 6 个月内进行了随访 VL。儿童的测试覆盖率略低，但年龄组和性别之间的重新测试覆盖率相似。在进行后续测试的人中，126 人（62%）表现出病毒抑制。其余 78 名患者患有世界卫生组织定义的病毒学失败； 41 名患者 (53%) 被医生转介接受更多依从性咨询，13 名患者 (15%) 改为二线治疗，相当于每 100 名患者年有 1.2 名患者转换为二线治疗。 24 名患者（32%）被转出、失访或未经医生复查。 VL 监测的“满负荷”成本为每位患者每年 35 美元。在资源有限的环境中，实现高质量的 VL 监测是可行且负担得起的，但需要密切监督以确保检测和咨询的良好覆盖。世界卫生组织定义的病毒学失败患者转用二线治疗的比率较低，这似乎反映了临床医生对持续依从性问题的怀疑。在我们的研究中，常规 VL 监测的主要影响是加强依从性，而不是增加二线治疗的使用。
Supplemental Digital Content is Available in the Text. To assess the programmatic quality (coverage of testing, counseling, and retesting), cost, and outcomes (viral suppression, treatment decisions) of routine viral load (VL) monitoring in Swaziland. Retrospective cohort study of patients undergoing routine VL monitoring in Swaziland (October 1, 2012 to March 31, 2013). Of 5563 patients eligible for routine VL testing monitoring in the period of study, an estimated 4767 patients (86%) underwent testing that year. Of 288 patients with detectable VL, 210 (73%) underwent enhanced adherence counseling and 202 (70%) had a follow-up VL within 6 months. Testing coverage was slightly lower in children, but coverage of retesting was similar between and age groups and sexes. Of those with a follow-up test, 126 (62%) showed viral suppression. The remaining 78 patients had World Health Organization–defined virologic failure; 41 (53%) were referred by the doctor for more adherence counseling, and 13 (15%) were changed to second-line therapy, equating to an estimated rate of 1.2 switches per 100 patient-years. Twenty-four patients (32%) were transferred out, lost to follow-up, or not reviewed by doctor. The “fully loaded” cost of VL monitoring was $35 per patient-year. Achieving good quality VL monitoring is feasible and affordable in resource-limited settings, although close supervision is needed to ensure good coverage of testing and counseling. The low rate of switch to second-line therapy in patients with World Health Organization–defined virologic failure seems to reflect clinician suspicion of ongoing adherence problems. In our study, the main impact of routine VL monitoring was reinforcing adherence rather than increasing use of second-line therapy.