Abstract：
BACKGROUND: Adolescents and young adults (AYA) living with HIV have been shown to have lower rates of viral load testing and viral suppression as compared to older adults. We examined trends over time and predictors of HIV viral load monitoring and viral suppression among AYA in a large HIV treatment programme in Dar es Salaam, Tanzania.
METHODS: We analysed longitudinal data of AYA aged 10-24 years initiated on antiretroviral therapy between January 2017 and October 2022. Trend models were used to assess changes in HIV viral load testing and viral suppression by calendar year. Generalised estimating equations were used to examine the relationship of sociodemographic and clinical factors with HIV viral load testing and viral suppression.
RESULTS: Out of 15,759 AYA, the percentage of those who received a 6-month HIV viral load testing increased from 40.6% in 2017 to 64.7% in 2022 and, a notable annual increase of 5.6% (p < 0.001). A higher HIV viral load testing uptake was observed among 20- to 24-year-olds (87.7%) compared to 10- to 19-year-olds (80.2%) (p < 0.001). The likelihood of not receiving an HIV viral load test within 12 months of antiretroviral therapy initiation was higher among 10- to 19-year-olds (adjusted odds ratio [aOR] = 1.7; 95% confidence interval [CI] = 1.4-2.0), advanced HIV disease (aOR = 1.3; 95% CI = 1.12-1.53), normal nutrition status at enrolment aOR 2.6 (95% CI = 1.59-4.26) and initiation of non-nucleoside reverse transcriptase inhibitors regimen aOR 1.2 (95% CI = 1.08-1.34). The proportion of AYA with viral suppression increased from 83.0% in 2017 to 94.6% in 2022. Notably, the overall trend in viral suppression increased significantly at 2.4% annually. The risk of not achieving viral suppression was greater among 10- to 14-year-olds (aOR = 2; 95% CI = 1.75-2.43) and 15- to 19-year-olds (aOR = 1.4; 95% CI = 1.24-1.58) as compared to 20-24 years; being male (aOR = 1.16; 95% CI = 1.02-1.32); undernourished (aOR = 1.53; 95% CI = 1.17-1.99); in WHO Stage II (aOR = 1.16; 95% CI = 1.02-1.33) and III (aOR = 1.21; 95% CI = 1.03-1.42) and being on an non-nucleoside reverse transcriptase inhibitors regimen (aOR = 1.32; 95% CI = 1.18-1.48).
CONCLUSIONS: HIV viral load testing uptake at 6 months of antiretroviral therapy initiation and viral suppression increased from 2017 to 2022; however, overall HIV viral load testing was suboptimal. Demographic and clinical characteristics can be used to identify AYA at greater risk for not having HIV viral load test and not achieving viral suppression.
METHODS: We analysed longitudinal data of AYA aged 10-24 years initiated on antiretroviral therapy between January 2017 and October 2022. Trend models were used to assess changes in HIV viral load testing and viral suppression by calendar year. Generalised estimating equations were used to examine the relationship of sociodemographic and clinical factors with HIV viral load testing and viral suppression.
RESULTS: Out of 15,759 AYA, the percentage of those who received a 6-month HIV viral load testing increased from 40.6% in 2017 to 64.7% in 2022 and, a notable annual increase of 5.6% (p < 0.001). A higher HIV viral load testing uptake was observed among 20- to 24-year-olds (87.7%) compared to 10- to 19-year-olds (80.2%) (p < 0.001). The likelihood of not receiving an HIV viral load test within 12 months of antiretroviral therapy initiation was higher among 10- to 19-year-olds (adjusted odds ratio [aOR] = 1.7; 95% confidence interval [CI] = 1.4-2.0), advanced HIV disease (aOR = 1.3; 95% CI = 1.12-1.53), normal nutrition status at enrolment aOR 2.6 (95% CI = 1.59-4.26) and initiation of non-nucleoside reverse transcriptase inhibitors regimen aOR 1.2 (95% CI = 1.08-1.34). The proportion of AYA with viral suppression increased from 83.0% in 2017 to 94.6% in 2022. Notably, the overall trend in viral suppression increased significantly at 2.4% annually. The risk of not achieving viral suppression was greater among 10- to 14-year-olds (aOR = 2; 95% CI = 1.75-2.43) and 15- to 19-year-olds (aOR = 1.4; 95% CI = 1.24-1.58) as compared to 20-24 years; being male (aOR = 1.16; 95% CI = 1.02-1.32); undernourished (aOR = 1.53; 95% CI = 1.17-1.99); in WHO Stage II (aOR = 1.16; 95% CI = 1.02-1.33) and III (aOR = 1.21; 95% CI = 1.03-1.42) and being on an non-nucleoside reverse transcriptase inhibitors regimen (aOR = 1.32; 95% CI = 1.18-1.48).
CONCLUSIONS: HIV viral load testing uptake at 6 months of antiretroviral therapy initiation and viral suppression increased from 2017 to 2022; however, overall HIV viral load testing was suboptimal. Demographic and clinical characteristics can be used to identify AYA at greater risk for not having HIV viral load test and not achieving viral suppression.
摘要：
背景：与老年人相比，患有HIV的青少年和年轻人（AYA）已被证明具有较低的病毒载量测试和病毒抑制率。我们研究了达累斯萨拉姆大型HIV治疗计划中AYA中HIV病毒载量监测和病毒抑制的趋势和预测因素，坦桑尼亚。
方法：我们分析了2017年1月至2022年10月开始接受抗逆转录病毒治疗的10-24岁AYA的纵向数据。趋势模型用于评估按日历年进行的HIV病毒载量测试和病毒抑制的变化。使用广义估计方程来检查社会人口统计学和临床因素与HIV病毒载量测试和病毒抑制的关系。
结果：在15,759AYA中，接受6个月HIV病毒载量检测的比例从2017年的40.6%增加到2022年的64.7%，显著的年增长率为5.6%(p<0.001)。与10至19岁（80.2%）相比，20至24岁的人群（87.7%）的HIV病毒载量检测摄取更高（p<0.001）。在开始抗逆转录病毒治疗的12个月内未接受HIV病毒载量测试的可能性在10至19岁的人群中较高（调整后的比值比[aOR]=1.7；95％置信区间[CI]=1.4-2.0），晚期HIV疾病（aOR=1.3；95%CI=1.12-1.53），入组时的正常营养状况aOR2.6(95%CI=1.59~4.26)和开始非核苷类逆转录酶抑制剂方案aOR1.2(95%CI=1.08~1.34).AYA抑制病毒的比例从2017年的83.0%增加到2022年的94.6%。值得注意的是,病毒抑制的总体趋势每年显著增加2.4%.与20-24岁相比，10至14岁（aOR=2；95％CI=1.75-2.43）和15至19岁（aOR=1.4；95％CI=1.24-1.58）的未实现病毒抑制的风险更大；男性（aOR=1.16；95％CI=1.02-1.32）；营养不良（WHO-95％OR=1.48％，非1.32阶段OR=1.48％CI=1.32
结论：从2017年到2022年，开始抗逆转录病毒治疗和病毒抑制6个月时，HIV病毒载量检测的摄取增加；然而，总体HIV病毒载量检测并不理想.人口统计学和临床特征可用于鉴定没有HIV病毒载量测试且不能实现病毒抑制的风险更大的AYA。
方法：我们分析了2017年1月至2022年10月开始接受抗逆转录病毒治疗的10-24岁AYA的纵向数据。趋势模型用于评估按日历年进行的HIV病毒载量测试和病毒抑制的变化。使用广义估计方程来检查社会人口统计学和临床因素与HIV病毒载量测试和病毒抑制的关系。
结果：在15,759AYA中，接受6个月HIV病毒载量检测的比例从2017年的40.6%增加到2022年的64.7%，显著的年增长率为5.6%(p<0.001)。与10至19岁（80.2%）相比，20至24岁的人群（87.7%）的HIV病毒载量检测摄取更高（p<0.001）。在开始抗逆转录病毒治疗的12个月内未接受HIV病毒载量测试的可能性在10至19岁的人群中较高（调整后的比值比[aOR]=1.7；95％置信区间[CI]=1.4-2.0），晚期HIV疾病（aOR=1.3；95%CI=1.12-1.53），入组时的正常营养状况aOR2.6(95%CI=1.59~4.26)和开始非核苷类逆转录酶抑制剂方案aOR1.2(95%CI=1.08~1.34).AYA抑制病毒的比例从2017年的83.0%增加到2022年的94.6%。值得注意的是,病毒抑制的总体趋势每年显著增加2.4%.与20-24岁相比，10至14岁（aOR=2；95％CI=1.75-2.43）和15至19岁（aOR=1.4；95％CI=1.24-1.58）的未实现病毒抑制的风险更大；男性（aOR=1.16；95％CI=1.02-1.32）；营养不良（WHO-95％OR=1.48％，非1.32阶段OR=1.48％CI=1.32
结论：从2017年到2022年，开始抗逆转录病毒治疗和病毒抑制6个月时，HIV病毒载量检测的摄取增加；然而，总体HIV病毒载量检测并不理想.人口统计学和临床特征可用于鉴定没有HIV病毒载量测试且不能实现病毒抑制的风险更大的AYA。
