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Abstract：
BACKGROUND: Numerous studies in South Africa have reported low HIV viral load (VL) suppression and high attrition rates within the pediatric HIV treatment program.
OBJECTIVE: Using routine laboratory data, we evaluated HIV VL monitoring, including mobility and overdue VL (OVL) testing, within 5 priority districts in South Africa.
METHODS: We performed a retrospective descriptive analysis of National Health Laboratory Service (NHLS) data for children and adolescents aged 1-15 years having undergone HIV VL testing between May 1, 2019, and April 30, 2020, from 152 facilities within the City of Johannesburg, City of Tshwane, eThekwini, uMgungundlovu, and Zululand. HIV VL test-level data were deduplicated to patient-level data using the NHLS CDW (Corporate Data Warehouse) probabilistic record-linking algorithm and then further manually deduplicated. An OVL was defined as no subsequent VL determined within 18 months of the last test. Variables associated with the last VL test, including age, sex, VL findings, district type, and facility type, are described. A multivariate logistic regression analysis was performed to identify variables associated with an OVL test.
RESULTS: Among 21,338 children and adolescents aged 1-15 years who had an HIV VL test, 72.70% (n=15,512) had a follow-up VL test within 18 months. Furthermore, 13.33% (n=2194) of them were followed up at a different facility, of whom 3.79% (n=624) were in a different district and 1.71% (n=281) were in a different province. Among patients with a VL of ≥1000 RNA copies/mL of plasma, the median time to subsequent testing was 6 (IQR 4-10) months. The younger the age of the patient, the greater the proportion with an OVL, ranging from a peak of 52% among 1-year-olds to a trough of 21% among 14-year-olds. On multivariate analysis, 2 consecutive HIV VL findings of ≥1000 RNA copies/mL of plasma were associated with an increased adjusted odds ratio (AOR) of having an OVL (AOR 2.07, 95% CI 1.71-2.51). Conversely, patients examined at a hospital (AOR 0.86, 95% CI 0.77-0.96), those with ≥2 previous tests (AOR 0.78, 95% CI 0.70-0.86), those examined in a rural district (AOR 0.63, 95% CI 0.54-0.73), and older age groups of 5-9 years (AOR 0.56, 95% CI 0.47-0.65) and 10-14 years (AOR 0.51, 95% CI 0.44-0.59) compared to 1-4 years were associated with a significantly decreased odds of having an OVL test.
CONCLUSIONS: Considerable attrition occurs within South Africa\'s pediatric HIV treatment program, with over one-fourth of children having an OVL test 18 months subsequent to their previous test. In particular, younger children and those with virological failure were found to be at increased risk of having an OVL test. Improved HIV VL monitoring is essential for improving outcomes within South Africa\'s pediatric antiretroviral treatment program.
OBJECTIVE: Using routine laboratory data, we evaluated HIV VL monitoring, including mobility and overdue VL (OVL) testing, within 5 priority districts in South Africa.
METHODS: We performed a retrospective descriptive analysis of National Health Laboratory Service (NHLS) data for children and adolescents aged 1-15 years having undergone HIV VL testing between May 1, 2019, and April 30, 2020, from 152 facilities within the City of Johannesburg, City of Tshwane, eThekwini, uMgungundlovu, and Zululand. HIV VL test-level data were deduplicated to patient-level data using the NHLS CDW (Corporate Data Warehouse) probabilistic record-linking algorithm and then further manually deduplicated. An OVL was defined as no subsequent VL determined within 18 months of the last test. Variables associated with the last VL test, including age, sex, VL findings, district type, and facility type, are described. A multivariate logistic regression analysis was performed to identify variables associated with an OVL test.
RESULTS: Among 21,338 children and adolescents aged 1-15 years who had an HIV VL test, 72.70% (n=15,512) had a follow-up VL test within 18 months. Furthermore, 13.33% (n=2194) of them were followed up at a different facility, of whom 3.79% (n=624) were in a different district and 1.71% (n=281) were in a different province. Among patients with a VL of ≥1000 RNA copies/mL of plasma, the median time to subsequent testing was 6 (IQR 4-10) months. The younger the age of the patient, the greater the proportion with an OVL, ranging from a peak of 52% among 1-year-olds to a trough of 21% among 14-year-olds. On multivariate analysis, 2 consecutive HIV VL findings of ≥1000 RNA copies/mL of plasma were associated with an increased adjusted odds ratio (AOR) of having an OVL (AOR 2.07, 95% CI 1.71-2.51). Conversely, patients examined at a hospital (AOR 0.86, 95% CI 0.77-0.96), those with ≥2 previous tests (AOR 0.78, 95% CI 0.70-0.86), those examined in a rural district (AOR 0.63, 95% CI 0.54-0.73), and older age groups of 5-9 years (AOR 0.56, 95% CI 0.47-0.65) and 10-14 years (AOR 0.51, 95% CI 0.44-0.59) compared to 1-4 years were associated with a significantly decreased odds of having an OVL test.
CONCLUSIONS: Considerable attrition occurs within South Africa\'s pediatric HIV treatment program, with over one-fourth of children having an OVL test 18 months subsequent to their previous test. In particular, younger children and those with virological failure were found to be at increased risk of having an OVL test. Improved HIV VL monitoring is essential for improving outcomes within South Africa\'s pediatric antiretroviral treatment program.
摘要：
背景：南非的许多研究报道了在儿科HIV治疗计划中，低HIV病毒载量（VL）抑制和高流失率。
目的：使用常规实验室数据，我们评估了HIVVL监测，包括移动性和逾期VL(OVL)测试，在南非的5个优先地区。
方法：我们对2019年5月1日至2020年4月30日期间接受HIVVL检测的1-15岁儿童和青少年国家卫生实验室服务（NHLS）数据进行了回顾性描述性分析，来自约翰内斯堡市的152个设施。茨瓦内市,eThekwini,uMgungundlovu,还有Zululand.使用NHLSCDW（公司数据仓库）概率记录链接算法将HIVVL测试级别的数据删除为患者级别的数据，然后进一步手动删除重复。OVL定义为在最后一次测试的18个月内没有确定后续VL。与上次VL测试相关的变量，包括年龄,性别,VL的发现，地区类型,和设施类型，被描述。进行多变量逻辑回归分析以确定与OVL检验相关的变量。
结果：在21,338名1-15岁的儿童和青少年中进行了HIVVL检测，72.70%(n=15,512)在18个月内进行了随访VL测试。此外，其中13.33%(n=2194)在不同的设施进行了随访，其中3.79％（n=624）在不同的地区，1.71％（n=281）在不同的省。在VL≥1000RNA拷贝/mL血浆的患者中，后续测试的中位时间为6个月(IQR4~10个月).病人的年龄越小，OVL的比例越大，从1岁儿童的52％的峰值到14岁儿童的21％的低谷。在多变量分析中，2例连续HIVVL发现≥1000RNA拷贝/mL血浆与OVL的校正比值比(AOR)增加相关(AOR2.07,95%CI1.71-2.51)。相反，在医院检查的患者（AOR0.86，95%CI0.77-0.96），既往测试≥2次(AOR0.78，95%CI0.70-0.86)，那些在农村地区接受检查的人(AOR0.63，95%CI0.54-0.73)，与1~4岁相比,5~9岁(AOR0.56,95%CI0.47~0.65)和10~14岁(AOR0.51,95%CI0.44~0.59)的老年组进行OVL检验的几率显著降低.
结论：在南非的儿科HIV治疗计划中发生了相当多的减员，超过四分之一的儿童在上一次测试后18个月进行了OVL测试。特别是,研究发现年龄较小的儿童和病毒学失败的儿童进行OVL测试的风险增加.在南非的儿科抗逆转录病毒治疗计划中，改善HIVVL监测对于改善结果至关重要。
目的：使用常规实验室数据，我们评估了HIVVL监测，包括移动性和逾期VL(OVL)测试，在南非的5个优先地区。
方法：我们对2019年5月1日至2020年4月30日期间接受HIVVL检测的1-15岁儿童和青少年国家卫生实验室服务（NHLS）数据进行了回顾性描述性分析，来自约翰内斯堡市的152个设施。茨瓦内市,eThekwini,uMgungundlovu,还有Zululand.使用NHLSCDW（公司数据仓库）概率记录链接算法将HIVVL测试级别的数据删除为患者级别的数据，然后进一步手动删除重复。OVL定义为在最后一次测试的18个月内没有确定后续VL。与上次VL测试相关的变量，包括年龄,性别,VL的发现，地区类型,和设施类型，被描述。进行多变量逻辑回归分析以确定与OVL检验相关的变量。
结果：在21,338名1-15岁的儿童和青少年中进行了HIVVL检测，72.70%(n=15,512)在18个月内进行了随访VL测试。此外，其中13.33%(n=2194)在不同的设施进行了随访，其中3.79％（n=624）在不同的地区，1.71％（n=281）在不同的省。在VL≥1000RNA拷贝/mL血浆的患者中，后续测试的中位时间为6个月(IQR4~10个月).病人的年龄越小，OVL的比例越大，从1岁儿童的52％的峰值到14岁儿童的21％的低谷。在多变量分析中，2例连续HIVVL发现≥1000RNA拷贝/mL血浆与OVL的校正比值比(AOR)增加相关(AOR2.07,95%CI1.71-2.51)。相反，在医院检查的患者（AOR0.86，95%CI0.77-0.96），既往测试≥2次(AOR0.78，95%CI0.70-0.86)，那些在农村地区接受检查的人(AOR0.63，95%CI0.54-0.73)，与1~4岁相比,5~9岁(AOR0.56,95%CI0.47~0.65)和10~14岁(AOR0.51,95%CI0.44~0.59)的老年组进行OVL检验的几率显著降低.
结论：在南非的儿科HIV治疗计划中发生了相当多的减员，超过四分之一的儿童在上一次测试后18个月进行了OVL测试。特别是,研究发现年龄较小的儿童和病毒学失败的儿童进行OVL测试的风险增加.在南非的儿科抗逆转录病毒治疗计划中，改善HIVVL监测对于改善结果至关重要。
