乌干达采用病毒载量(VL)测试来监测HIV治疗成功和病毒学失败。然而,关于在HIV诊所中在实践中如何遵循VL检测指南的数据很少.这项研究确定了对VL测试的国家指南的遵守,障碍,乌干达西南部接受ART治疗的HIV感染者(PLHIV)的相关因素。方法:我们于2021年4月至5月在乌干达西南部的四家HIV诊所进行了一项横断面混合方法研究。使用记录年龄的检查表审查患者图表,性别,和医疗机构的水平,ART开始的日期,绘制VL样本的日期,艺术路线,患者坚持ART。连续数据使用平均值和中位数进行汇总,卡方用于分类数据。我们进行了回归分析,以确定在95%的显著性水平与坚持病毒载量测试指南相关的因素。关键线人采访了医疗机构的管理人员,进行了ART诊所和实验室,并进行了主题分析,以探讨遵守VL测试指南的障碍.
参与者的平均(SD)年龄为39.9(±13.1)岁,39.5%为男性,45.8%的人在综合医院接受了治疗,接受ART的中位持续时间为5年(IQR;3-7)。在回顾的395例患者图表中,317人根据指南进行了VL测试(80.3%)(定义为截止日期后一个月)。在医院接受治疗(aOR=2.20;95CI1.30-3.70;p=0.002)和患者年龄增加(aOR=1.02;95CI1.02-1.06;p=0.020)是与遵守VL测试指南相关的因素。供应商将VL结果的长周转时间和VL检测试剂盒不足作为障碍。
我们发现,在乌干达西南部的ART上,PLHIV对VL测试指南的依从性欠佳。增加患者年龄和在更高级别的医疗机构获得护理与基于指南的病毒VL测试相关。VL测试结果的长周转时间和测试套件的不足阻碍了对VL监测指南的遵守。针对年轻艾滋病毒感染者和较低级别的卫生设施的战略,需要增加耗材的库存并缩短VL结果的周转时间,以提高对VL测试指南的依从性。
Uganda adapted Viral load (VL) testing for monitoring HIV treatment success and virologic failure. However, there is a paucity of data on how the VL testing
guidelines are followed in practice in the HIV clinics. This study determined the adherence to national
guidelines on VL testing, barriers, and associated factors in persons living with HIV (PLHIV) on ART in southwestern Uganda. METHODS: We conducted a cross-sectional mixed methods study from April to May 2021 at four HIV clinics in southwestern Uganda. Patient chart review using a checklist that captured age, gender, and level of a healthcare facility, dates of ART initiation, dates VL specimens were drawn, line of ART, patient adherence to ART was done. Continuous data were summarized using mean and median and Chi-square was used for categorical data. We performed regression analysis to determine factors associated with adherence to viral load testing guidelines at a 95% level of significance. Key informant interviews with managers of the health facility, ART clinic and laboratory were carried out, and thematic analysis was conducted to explore barriers to adherence to VL testing guidelines.
The participants\' mean (SD) age was 39.9(± 13.1) years, 39.5% were male, 45.8% received care at a general hospital and median duration on ART was 5 years (IQR;3-7). Of the 395 patient charts reviewed, 317 had their VL testing (80.3%) per the
guidelines (defined as up to one month post due date). Receiving care at a hospital (aOR = 2.20; 95%CI 1.30-3.70; p = 0.002) and increasing patient age (aOR = 1.02; 95%CI 1.02-1.06; p = 0.020) were the factors associated with adhering to VL testing guidelines. Long turnaround time of VL results and insufficient VL testing kits were cites by providers as barriers.
We found suboptimal adherence to VL testing
guidelines in PLHIV on ART in southwestern Uganda. Increasing patient age and getting care at a higher-level health facility were associated with
guideline-based viral VL testing. Long turnaround time of VL test results and inadequate test kits hindered compliance to VL monitoring guidelines. Strategies that target young PLHIV and lower-level health facilities, increase the stock of consumables and shorten VL results turnaround time are needed to improve adherence to VL testing guidelines.