Enhanced adherence counselling and viral load suppression in HIV seropositive patients with an initial high viral load in Harare, Zimbabwe: Operational issues
Enhanced adherence counselling and viral load suppression in HIV seropositive patients with an initial high viral load in Harare, Zimbabwe: Operational issues
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DOI：
10.1371/journal.pone.0211326
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发表时间：
2019-02-05
期刊：
影响因子：
3.7
通讯作者：
Apollo, Tsitsi
中科院分区：
文献类型：
--
作者：
Bvochora, Talent;Satyanarayana, Srinath;Apollo, Tsitsi
在接受抗逆转录病毒治疗（ART）的艾滋病毒感染者（PLHIV）中，必须识别高血液病毒载量（VLs）（>= 1000拷贝/ml）的人，提供3个月的强化依从性咨询（EAC），并评估VL抑制（< 1000拷贝/ml）。我们的研究目的是确定2016年8月1日至2017年7月31日在津巴布韦哈拉雷威尔金斯医院接受病毒载量检测的人群中病毒载量高的比例。对病毒载量高的患者进行评估；a)报名参加EAC的比例，与报名参加EAC相关的人口统计学和临床特征，b)实现病毒载量抑制的比例以及与病毒载量抑制相关的人口统计学和临床特征。设计采用常规收集的项目数据进行回顾性队列研究。数据收集自2016年8月1日至2017年7月31日期间接受抗逆转录病毒治疗且病毒载量高的PLHIV患者。结果2016年8月1日至2017年7月31日期间接受抗逆转录病毒治疗的5573例hiv感染者中，4787例（85.9%）接受了VL检测，646例（13.5%）VL高。在这646例患者中，只有489例（75.7%）被纳入EAC，其中444例（69%）接受了重复VL测试。3个月，201例（31.2%）实现VL抑制。与VL抑制可能性较高独立相关的临床特征有：a)接受3次EAC；b)接受二线ART治疗。初始VL水平为0.5 000拷贝/ml与较低的病毒抑制可能性相关。结论常规VL检测水平较高，但在将高VL的PLHIV纳入EAC并实现VL抑制方面存在较大的程序性差距。在这种情况下，EAC在实现病毒载量抑制方面的全部潜力尚未实现。这些差距的原因需要在未来的研究中进行评估，并通过适当改变政策/做法来解决。
BackgroundIn people living with HIV (PLHIV) who are on anti-retroviral therapy (ART), it is essential to identify persons with high blood viral loads (VLs) (>= 1000 copies/ml), provide enhanced adherence counselling (EAC) for 3 months and assess for VL suppression (< 1000 copies/ml).ObjectiveOur study objectives were to determine the proportion who had a high viral load in those people who underwent viral load testing between 1 August 2016-31 July 2017 at Wilkins Hospital, Harare, Zimbabwe. Of those with high viral load to assess; a) the proportion who enrolled for EAC, the demographic and clinical characteristics associated with enrolment for EAC and, b) the proportion who achieved viral load suppression and demographic, clinical characteristics associated with viral load suppression.DesignRetrospective cohort study using routinely collected programme data. Data was collected from PLHIV who were on ART and had a high viral load from 1 August 2016 to 31 July 2017.ResultsOf 5,573 PLHIV on ART between 1 August 2016 and 31 July 2017, 4787 (85.9%) had undergone VL testing and 646 (13.5%) had high VLs. Of these 646, only 489 (75.7%) were enrolled for EAC, of whom 444 (69%) underwent a repeat VL test at. 3 months with 201 (31.2%) achieving VL suppression. The clinical characteristics that were independently associated with higher probability of VL suppression were: a) undergoing 3 sessions of EAC; b) being on 2nd line ART. Initial VL levels >5,000 copies/ml were associated with lower probability of viral suppression.ConclusionThe routine VL testing levels were high, but there were major programmatic gaps in enrolling PLHIV with high VLs into EAC and achieving VL suppression. The full potential of EAC on achieving viral load suppression has not been achieved in this setting. The reasons for these gaps need to be assessed in future research studies and addressed by suitable changes in policies/practices.