viral suppression

病毒抑制
  • 文章类型: Journal Article
    2022年,莫桑比克推出了Dolutegravir10mg(pDTG),作为儿童抗逆转录病毒治疗的一部分,体重<20公斤的儿童。在国家推广期间了解现实世界的挑战可以在资源有限的环境中加强卫生系统。
    我们描述了过渡率,和新的开始,pDTG,pDTG后的病毒载量抑制(VLS),以及感染艾滋病毒儿童中与VLS相关的因素。
    我们进行了一项涉及9岁以下儿童的回顾性队列研究,并从临床来源提取数据。我们使用逻辑回归来评估VLS和pDTG启动预测因子。
    在1353个孩子中,1146起始的pDTG;196(14.5%)没有记录体重。pDTG后开关,98.9%(950/961)的儿童维持相同的核苷逆转录酶抑制剂骨架。开始阿巴卡韦/拉米夫定+pDTG后,834名(72.8%)儿童仍在接受该方案,156(13.6%)关闭(大多数为Dolutegravir50mg),22(1.9%)有≥2种锚定药物转换;134(11.7%)没有记录的随访方案。与pDTG启动或转换相关的因素是年龄较小(调整比值比[AOR]=0.71[0.63-0.80])和体重记录(AOR=55.58[33.88-91.18])。在pDTG后≥5个月进行病毒载量(VL)测试的294名儿童中,VLS为75.5%(n=222/294)。有治疗经验的儿童pDTG前VLS率为56.5%(n=130/230)。与VLS相关的因素是年龄较大(AOR=1.18[1.03-1.34])和既往VLS(AOR=2.27[1.27-4.06])。
    大多数符合条件的儿童根据指南启动了pDTG,改进pDTG后VLS。挑战包括启动后无法解释的关闭pDTG,VL覆盖率低,临床记录中文件不足。
    UNASSIGNED: In 2022, Mozambique introduced Dolutegravir 10mg (pDTG), as part of paediatric antiretroviral therapy for children weighing < 20 kg. Understanding real-world challenges during national rollout can strengthen health systems in resource-limited settings.
    UNASSIGNED: We described the transition rate to, and new initiation of, pDTG, viral load suppression (VLS) post-pDTG, and factors associated with VLS among children living with HIV.
    UNASSIGNED: We conducted a retrospective cohort study involving children aged < 9 years and abstracted data from clinical sources. We used logistic regression to assess VLS and pDTG initiation predictors.
    UNASSIGNED: Of 1353 children, 1146 initiated pDTG; 196 (14.5%) had no recorded weight. Post-pDTG switch, 98.9% (950/961) of children maintained the same nucleoside reverse transcriptase inhibitor backbone. After initiating Abacavir/Lamivudine+pDTG, 834 (72.8%) children remained on the regimen, 156 (13.6%) switched off (majority to Dolutegravir 50mg), 22 (1.9%) had ≥ 2 anchor drug switches; 134 (11.7%) had no documented follow-up regimen. Factors associated with pDTG initiation or switch were younger age (adjusted odds ratio [AOR] = 0.71 [0.63-0.80]) and a recorded weight (AOR = 55.58 [33.88-91.18]). VLS among the 294 children with a viral load (VL) test after ≥ 5 months post-pDTG was 75.5% (n = 222/294). Pre-pDTG VLS rate among treatment-experienced children was 56.5% (n = 130/230). Factors associated with VLS were older age (AOR = 1.18 [1.03-1.34]) and previous VLS (AOR = 2.27 [1.27-4.06]).
    UNASSIGNED: Most eligible children initiated pDTG per guidelines, improving post-pDTG VLS. Challenges included unexplained switches off pDTG after initiation, low VL coverage and inadequate documentation in clinic records.
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  • 文章类型: Journal Article
    艾滋病毒/艾滋病(PLHIV)患者容易出现其他可能由疾病或抗逆转录病毒药物引起的健康问题。这些人经历了疾病的其他社会心理方面,这可能会对他们的生活质量和整体治疗结果产生负面影响。这项研究评估了成人PLHIV的药物相关负担和病毒学应答。
    这项横断面研究涉及417名HIV阳性成年人,他们在国家专科医院贡贝接受了至少一年的联合抗逆转录病毒治疗。尼日利亚。使用药物治疗生活问卷版本3(LMQ-3)测量患者的用药经验。对于不可检测的HIVRNA水平,在病毒载量<1000拷贝/ml和20拷贝/ml下评估病毒学抑制。使用独立t检验或单向方差分析(ANOVA)将LMQ-3评分与参与者的特征进行比较。采用回归分析来确定病毒抑制和药物相关负担的预测因子。在95%置信区间的P值<0.05被认为具有统计学意义。
    在本研究中纳入的417例PLHIV中,271(65%)被归类为WHO第一阶段ART启动,93.8%实现了病毒抑制,其中291(69.5%)为女性。382名患者中的大多数(91.6%)采用基于dolutegravir的治疗方案,在开始抗逆转录病毒治疗(ART)时没有结核病诊断(82.5%),接受ART治疗6-10年(46.3%).只有67.6%的人口有适度的药物相关负担。女性(p<0.0005),未抑制的病毒载量(p=0.01),第二行ART(p=0.03),ART开始时的结核病(p=0.02),和就业(p=0.003)与药物相关负担显著相关。病毒抑制的预测因子是高度的药物相关负担(AOR,0.12;95%CI,0.02-0.59),而未抑制的病毒载量(p=0.01)和女性(p=0.002)是药物相关负担的独立预测因子。
    这项研究的发现表明,大多数患者在中等程度的药物相关负担下实现了病毒抑制。有针对性的干预措施应针对年轻患者,女性和未抑制病毒载量的患者。
    UNASSIGNED: People living with HIV/AIDS (PLHIV) are prone to other health issues that may result from the disease or antiretroviral medicines. These persons experience other psychosocial aspects of the illness, which may negatively affect their quality of life and overall treatment outcomes. This study assessed the medication-related burden and virological response of adult PLHIV.
    UNASSIGNED: This cross-sectional study involved 417 HIV-positive adults who had been on combined antiretroviral therapy for at least a year at the State Specialist Hospital Gombe. Nigeria. Patient medication experience was measured using the Living with Medication Questionnaire version-3 (LMQ-3). Virological suppression was assessed at viral loads <1000 copies/ml and 20 copies/ml for undetectable HIV RNA levels. The LMQ-3 scores were compared with the participants\' characteristics using independent t-tests or one-way analysis of variance (ANOVA). Regression analyses was employed to identify the predictors of viral suppression and medication-related burden. P value <0.05 at 95% confidence interval was considered statistically significant.
    UNASSIGNED: Of the 417 PLHIV included in this study, 271 (65%) were classified as WHO Stage 1 ART initiation, 93.8% achieved viral suppression with 291 (69.5%) whom were females. The majority of patients 382 (91.6%) were on a dolutegravir-based regimen, had no tuberculosis diagnosis at antiretroviral therapy (ART) initiation (82.5%) and were 6-10 years on ART (46.3%). Only 67.6% of the population had a moderate medication-related burden. Female sex (p < 0.0005), unsuppressed viral load (p = 0.01), second-line ART (p = 0.03), tuberculosis at ART initiation (p = 0.02), and employment (p = 0.003) were significantly associated with medication-related burden. The predictor of viral suppression was high degree of medication-related burden (AOR, 0.12; 95% CI, 0.02-0.59) while unsuppressed viral load (p = 0.01) and female gender (p = 0.002) were independent predictors of medication related burden.
    UNASSIGNED: The findings from this study revealed that majority of the patients achieved viral suppression with moderate degree of medication-related burden. Targeted interventions should be directed toward younger patients, females and patients with unsuppressed viral loads.
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  • 文章类型: Journal Article
    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。
    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.
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  • 文章类型: Journal Article
    我们评估了有临床相关性的症状性神经认知障碍(NCI)和无症状性NCI是否会影响HIV控制以及ART依从性在这种关系中的作用。对322PLWH在ART上的神经认知评价(NCE)前2年和后2年NCI与病毒掌握关系的不雅察研讨。病毒载量(VL)被定义为检测不到,极低电平(VLLV),低电平(LLV),或高水平病毒血症(HLV),并将加班归类为持久性(p;在同一最差类别中≥2个连续值),病毒衰竭(VF;≥1HLV,需要ART改变),或最优控制。坚持是ART涵盖的天数的比例。使用Frascati标准。对与病毒控制相关的因素进行调整模型。中介分析通过依从性从NCI到病毒控制的路径中的知情因果关系。敏感性分析集中在NCE之后的一年,仅针对之前具有最佳病毒控制的参与者。在参与者中(53±10年,CD4+T细胞630/微升),41.6%和10.8%表现为无症状和有症状的NCI。超过3,304个VL,8.4%和22.1%的参与者有VF和pLLV/pVLLV。有症状和无症状的NCI均与VF(aRRR=8.5;aRRR=4.3)和pVLLV/pLLV(aRRR=4.3;aRRR=2.1)独立相关。特定认知域显示出与VL类别的独立关联(模型\'P<0.001)。粘附部分介导了这些关系(模型P<0.001)。敏感性分析证实了这些发现。病毒控制不良的患病率和严重程度随着NCI严重程度的增加而增加,艺术坚持调解这种关系。Frascati标准使用的当前“无症状”归因可能会忽略临床风险。
    We assessed whether symptomatic neurocognitive impairment (NCI) and asymptomatic NCI -of which the clinical relevance is debated- affect HIV control and the role of ART adherence in this relationship. Observational study on the relationship between NCI and viral control during the 2 years before and the 2 after the neurocognitive evaluation (NCE) of 322 PLWH on ART. Viral load (VL) was defined as undetectable, very low-level (VLLV), low-level (LLV), or high-level viremia (HLV), and classified overtime as persistent (p; ≥2 consecutive values in the same worst category), viral failure (VF; ≥1 HLV requiring ART changes), or optimal control. Adherence was the proportion of days covered by ART. Frascati criteria were used. Adjusted models were performed for factors associated with viral control. Mediation analyses informed causality in the path from NCI to viral control through adherence. Sensitivity analyses were focused on the year following NCE for only participants with optimal viral control before. Among the participants (53 ± 10 years, CD4 + T-cells 630/µL), 41.6% and 10.8% presented asymptomatic and symptomatic NCI. Over 3,304 VLs, 8.4% and 22.1% of participants had VF and pLLV/pVLLV. Both symptomatic and asymptomatic NCI were independently associated with VF (aRRR = 8.5; aRRR = 4.3) and pVLLV/pLLV (aRRR = 4.3; aRRR = 2.1). Specific cognitive domains showed independent associations with VL categories (models\' P < 0.001). Adherence partially mediated these relationships (models\' P < 0.001). Sensitivity analysis confirmed these findings. Prevalence and severity of poor viral control increased as the severity of NCI increased, with ART adherence mediating this relationship. The current \"asymptomatic\" attribution used by Frascati\'s criteria could overlook clinical risks.
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  • 文章类型: Journal Article
    目标:研究美国成年人中经济和西班牙裔/拉丁裔-白人种族隔离与艾滋病毒结果的极端集中指数(ICE)措施(结构性种族主义的代理)之间的关联
    方法:人口普查级别的艾滋病毒诊断,在诊断后1个月内与艾滋病毒医疗联系(联系),使用来自国家HIV监测系统的2021年诊断后6个月内的病毒抑制(病毒抑制)数据。从美国社区调查中获得了三项ICE措施:ICE收入(收入隔离),ICErace(西班牙裔/拉丁裔-白人种族隔离),和ICE收入+种族(西班牙裔/拉丁裔-白人种族化的经济隔离)。使用HIV诊断的比率(RR)以及连锁和病毒抑制的患病率(PR)来检查ICE五分位数之间HIV结局的差异,以Quintile5(Q5:最特权)为参照组,并根据选定的特征进行调整。
    结果:在32,529名成年人中,ICE收入(28.7)和ICE收入+种族(28.4)的Quintile1(Q1:最贫困)诊断率最高,ICErace(27.0)的Q2诊断率最高.我们还观察到,与Q5相比,Q1中HIV诊断中的RR较高,连锁和病毒抑制中的PR较低(ICErace连锁除外)。在男性(诊断)中观察到ICE测量中较高的RR和较低的PR,18-34岁(诊断和联系)和≥45岁(病毒抑制)的成年人,以及南方的成年人(所有3个艾滋病毒结果)。
    结论:在更多西班牙裔/拉丁裔-白人种族化的经济隔离社区中,获得护理/治疗的障碍使艾滋病毒对人口的不成比例的影响长期存在。消除系统性种族主义/隔离造成的艾滋病毒护理/治疗障碍可能会改善艾滋病毒的结果并减少差距。
    OBJECTIVE: To examine associations between Index of Concentration at the Extremes (ICE) measures (proxy for structural racism) for economic and Hispanic/Latino-White racial segregation and HIV outcomes among adults in the U.S.
    METHODS: Census tract-level HIV diagnoses, linkage to HIV medical care within 1 month of diagnosis (linkage), and viral suppression within 6 months of diagnosis (viral suppression) data for 2021 from the National HIV Surveillance System were used. Three ICE measures were obtained from the American Community Survey: ICEincome (income segregation), ICErace (Hispanic/Latino-White racial segregation), and ICEincome + race (Hispanic/Latino-White racialized economic segregation). Rate ratios (RRs) for HIV diagnosis and prevalence ratios (PRs) for linkage and viral suppression were used to examine differences in HIV outcomes across ICE quintiles with Quintile5 (Q5: most privileged) as reference group and adjusted by selected characteristics.
    RESULTS: Among the 32,529 adults, diagnosis rates were highest in Quintile1 (Q1: most deprived) for ICEincome (28.7) and ICEincome + race (28.4) and Q2 for ICErace (27.0). We also observed higher RRs in HIV diagnosis and lower PRs in linkage and viral suppression (except for ICErace for linkage) in Q1 compared to Q5. Higher RRs and lower PRs in ICE measures were observed among males (diagnosis), adults aged 18‒34 (diagnosis and linkage) and aged ≥ 45 (viral suppression), and among adults in the South (all 3 HIV outcomes).
    CONCLUSIONS: Barriers in access to care/treatment in more Hispanic/Latino-White racialized economic segregated communities perpetuate the disproportionate impact of HIV on the population. Removing barriers to HIV care/treatment created by systemic racism/segregation may improve HIV outcomes and reduce disparities.
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  • 文章类型: Journal Article
    感染艾滋病毒(ALHIV)的青少年面临着独特的挑战,导致在实现和维持抑制病毒载量方面存在持续的差距。尽管可以随时获得有效的循证干预措施来解决青少年的治疗差距,资源有限的卫生系统,艾滋病毒高流行地区面临着实施这些措施以实现流行病控制的挑战。这里,我们描述了卫生系统的反应,以解决温得和克抗逆转录病毒治疗未抑制的ALHIV的治疗差距,纳米比亚。
    我们于2023年6月至10月在温得和克进行了定性的描述性和探索性研究。十九名故意选择的关键线人,从儿科艾滋病毒项目经理到医疗保健提供者,被采访了。深入访谈是录音和逐字转录的。将转录本上传到ATLAS。并接受专题分析。
    四个主要主题阐明了与坚持和保留以及干预和支持计划形式的卫生系统应对措施有关的挑战。ALHIV面临的主要坚持和保留挑战是心理健康问题,行为和药物相关的挑战,照顾和社会支持不足。卫生系统应对已确定的挑战包括提供社会心理支持,同行支持,优化治疗和护理,以及有效服务交付模式的利用。确定的关键卫生系统支持要素包括能力充足的人力资源,高效的药物供应链系统,创造和维护最佳护理的有利环境,和强大的监控系统是计划成功的关键。
    卫生系统为解决温得和克未抑制的ALHIV的剩余治疗差距而做出的反应是多种多样的,尽管以证据为基础,似乎是孤立的。我们建议协调,多方面的指导,整合社会心理,治疗,care,和同行主导的支持,并加强以客户为中心的差异化服务模式,为未受压制的青少年提供服务。
    UNASSIGNED: Adolescents living with HIV (ALHIV) face unique challenges that result in persistent gaps in achieving and maintaining suppressed viral load. Although effective evidence-based interventions to address treatment gaps in adolescents are readily available, health systems in resource-constrained, high HIV prevalence settings are challenged to implement them to achieve epidemic control. Here, we describe the health system responses to address the treatment gap of unsuppressed ALHIV on antiretroviral therapy in Windhoek, Namibia.
    UNASSIGNED: We conducted a qualitative descriptive and exploratory study in Windhoek between June and October 2023. Nineteen purposively selected key informants, ranging from pediatric HIV program managers to healthcare providers, were interviewed. In-depth interviews were audio-recorded and transcribed verbatim. The transcripts were uploaded to ATLAS.ti and subjected to thematic analysis.
    UNASSIGNED: The four main themes elucidated challenges related to adherence and retention as well as health system responses in the form of interventions and support programs. The predominant adherence and retention challenges faced by ALHIV were mental health issues, behavioral and medication-related challenges, and inadequate care and social support. The health system responses to the identified challenges included providing psychosocial support, peer support, optimization of treatment and care, and the utilization of effective service delivery models. Key health system support elements identified included adequately capacitated human resources, efficient medication supply chain systems, creating and maintaining an enabling environment for optimum care, and robust monitoring systems as essential to program success.
    UNASSIGNED: The health system responses to address the remaining treatment gaps of unsuppressed ALHIV in Windhoek are quite varied and, although evidence-based, appear to be siloed. We recommend harmonized, multifaceted guidance, integrating psychosocial, treatment, care, and peer-led support, and strengthening client-centred differentiated service delivery models for unsuppressed adolescents.
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  • 文章类型: Journal Article
    在实现艾滋病毒流行病控制的艾滋病毒护理和治疗目标方面,艾滋病毒感染者(ALHIV)的青少年落后于年幼的儿童和成人。青少年的治疗结果可能会受到他们在艾滋病毒项目中提供的支持下的经验的影响。我们报告了在纳米比亚初级医疗机构中目前的支持下,未受到病毒抑制的青少年及其照顾者的经历。
    在温得和克的13个公共初级卫生保健设施中进行了定性的描述性和探索性研究,纳米比亚。在2023年8月至9月之间,总共对未受抑制的青少年(n=14)及其照顾者(n=11)进行了25次深入访谈。录音采访被逐字转录,并上传到ATLAS。ti软件,并进行主题内容分析。
    从我们的分析中得出了对未受抑制的青少年的三个主要支持域,即:社会心理,临床和护理,社会经济支持。心理社会支持主要通过同伴支持(青少年俱乐部和治疗支持者)和加强依从性咨询来提供。临床和护理支持包括实施青少年友好型艾滋病毒服务,差异化的服务交付方式,以及护理人员和医护人员护理支持,以提高ART依从性,门诊就诊和持续参与护理。为营养支持提供了社会经济支持,运输到门诊部,和学校用品,以及创收项目。
    社会心理,临床和护理,和社会经济支持是解决青少年在实现病毒抑制方面面临挑战的需求的关键因素。卫生系统可能受益于整个社会和整个政府的方法,以满足ALHIV的需求,这些需求超出了卫生服务提供的范围,例如营养,教育和社会经济对ALHIV健康和福祉的影响。
    UNASSIGNED: Adolescents living with HIV (ALHIV) lag behind younger children and adults in the achievement of HIV care and treatment targets for HIV epidemic control. Treatment outcomes for adolescents may be influenced by their experiences with the support provided in HIV programs. We report on the experiences of virally unsuppressed adolescents and their caregivers with the current support in primary healthcare settings in Namibia.
    UNASSIGNED: A qualitative descriptive and exploratory study was conducted in 13 public primary healthcare facilities in Windhoek, Namibia. A total of 25 in-depth interviews were conducted with unsuppressed adolescents (n = 14) and their caregivers (n = 11) between August and September 2023. The audio-recorded interviews were transcribed verbatim, and uploaded into ATLAS.ti software, and subjected to thematic content analysis.
    UNASSIGNED: Three main support domains for the unsuppressed adolescents emerged from our analysis, namely: psychosocial, clinical and care, and socioeconomic support. The psychosocial support was delivered through peer support (teen clubs and treatment supporters) and enhanced adherence counselling mostly. The clinical and care support included implementing adolescent-friendly HIV services, differentiated service delivery approaches, and caregivers and healthcare worker care support for improved ART adherence, clinic attendance and continuous engagement in care. Socioeconomic support was provided for nutritional support, transport to access clinics, and school supplies, as well as income-generating projects.
    UNASSIGNED: Psychosocial, clinical and care, and socioeconomic support are key elements in addressing the needs of adolescents challenged with achieving viral suppression. Health systems may benefit from whole-of-society and whole-of-government approaches to meet the needs of ALHIV that are beyond the scope of health service delivery such as nutritional, education and socioeconomic influences on both the health and well-being of ALHIV.
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  • 文章类型: Journal Article
    背景:世界卫生组织实施了多种艾滋病毒预防政策,并努力到2020年实现90-90-90目标,到2030年实现95-95-95目标,即95%的艾滋病毒感染者知道自己的艾滋病毒状况,95%的艾滋病毒感染者接受持续的护理和药物治疗,95%的HIV患者表现出病毒抑制。然而,如何测量病毒抑制的状态各不相同,很难指出艾滋病毒护理的质量。该研究旨在检查这些情况下的长期病毒载量抑制,并探索影响长期病毒载量控制的潜在因素。
    方法:这项研究分析了从通知到2019-2020年期间仍然存活的HIV患者的病毒载量检测数据。计算了三个指标,包括持久的病毒抑制,病毒血症复制年,病毒载量>1,500拷贝/毫升,评估它们之间的差异。
    结果:在纳入研究的27,706例中,持续病毒载量抑制的比例为87%,4%的病毒载量超过1,500拷贝/毫升。从通知到病毒载量抑制的平均持续时间为154天,病毒年复制的几何平均值为90拷贝*年/毫升。关于最后可用的病毒载量测量,96%的病例有检测不到的病毒载量。然而,我们观察到9.3%的病例,虽然他们最后一次测量有检测不到的病毒载量,没有显示一致的长期病毒载量抑制。与非持续性病毒载量抑制相关因素的分析显示,年轻年龄组的风险更高。具有高中或以下教育水平的个人,注射吸毒者,东部地区的病例,那些在地区医院寻求治疗的人,有耐药性数据的病例,医疗保健连续性较低的个人,以及在研究期间初始CD4计数低于350的患者。
    结论:建议将其与持续病毒载量抑制指标相结合,以更准确地评估感染社区内HIV传播的风险。
    The World Health Organisation has implemented multiple HIV prevention policies and strived to achieve the 90-90-90 goal by 2020, achieving the 95-95-95 goal by 2030, which refers to 95% of patients living with HIV knowing their HIV status, 95% of patients living with HIV receiving continual care and medication, and 95% of patients living with HIV exhibiting viral suppression. However, how to measure the status of viral suppression varies, and it is hard to indicate the quality of HIV care. The study aimed to examine the long-term viral load suppression in these cases and explore potential factors affecting the control of long-term viral load.
    This study analyzed viral load testing data from HIV patients who are still alive during the period from notification up to 2019-2020. Three indicators were calculated, including durable viral suppression, Viremia copy-years, and Viral load > 1,500 copies/ml, to assess the differences between them.
    Among the 27,706 cases included in the study, the proportion of persistent viral load suppression was 87%, with 4% having viral loads exceeding 1,500 copies/ml. The average duration from notification to viral load suppression was 154 days, and the geometric mean of annual viral replication was 90 copies*years/ml. Regarding the last available viral load measurement, 96% of cases had an undetectable viral load. However, we observed that 9.3% of cases, while having an undetectable viral load for their last measurement, did not show consistent long-term viral load suppression. An analysis of factors associated with non-persistent viral load suppression revealed higher risk in younger age groups, individuals with an educational level of high school or below, injection drug users, cases from the eastern region, those seeking care at regional hospitals, cases with drug resistance data, individuals with lower healthcare continuity, and those with an initial CD4 count below 350 during the study period.
    The recommendation is to combine it with the indicator of sustained viral load suppression for a more accurate assessment of the risk of HIV transmission within the infected community.
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  • 文章类型: Journal Article
    病毒学非抑制不仅与人类免疫缺陷病毒(HIV)传播给他人的风险增加有关;围产期和性传播,但它也降低了接受抗逆转录病毒治疗(ART)的个体的预期寿命.这项研究旨在确定uMgungundlovu地区特定医疗机构中ART患者的病毒学非抑制水平。该分区在夸祖鲁纳塔尔省(KZN)的艾滋病毒传播率高,是2018年该地区艾滋病毒感染率最高的地区之一;15-49岁男女的人口加权艾滋病毒感染率为36.3%,是全国平均患病率18.8%的两倍。
    这个描述性的,横截面,在HIV阳性的参与者中进行了定量研究,18岁及以上,并于2017年1月至2019年1月在Vulindlela分区的选定PHC设施中启动ART。医疗机构治疗登记册,使用患者医疗档案和面对面访谈来收集数据,并将这些数据捕获到Excel电子表格中,清洁,在输入Epiinfo17进行统计分析之前编码。进行Logistic回归分析以探讨与病毒学非抑制相关的因素。
    研究发现大多数参与者是女性(240/401(60%))。参与者的平均年龄为38.1(SD=11.2),大多数参与者年龄在29至39岁之间(167(41.7%))。在10%(40/401)的参与者中观察到病毒学无抑制。在已婚的参与者中,病毒学非抑制的几率更高(aOR4.76,95%CI1.49-15.19;p=0.008)。
    10%的病毒学非抑制转化为90%的病毒抑制,低于联合国艾滋病规划署95-95-95战略的目标。隐藏和跳过药物表明不披露如何继续阻碍艾滋病毒治疗的依从性。已婚参与者中病毒学不抑制的可能性很高,表明未披露HIV阳性状态,或缺乏配偶支持。
    UNASSIGNED: virological non-suppression is not only associated with increased risk of transmission of the Human Immunodeficiency virus (HIV) to others; perinatally and sexually, but it also decreases the life expectancy among the individuals who are on antiretroviral therapy (ART). This study sought to determine the level of virological non-suppression among ART patients from selected health facilities of a sub-district in uMgungundlovu district. This sub-district has high HIV transmission rates in KwaZulu Natal (KZN) and had one of the highest HIV prevalence in the district in 2018; population weighted HIV prevalence of 36.3% among men and women aged 15-49 years old, which was twice the average national prevalence of 18.8%.
    UNASSIGNED: this descriptive, cross-sectional, and quantitative study was conducted among participants who were HIV-positive, 18 years old and above, and initiated on ART between January 2017 and January 2019 at selected PHC facilities of Vulindlela sub district. Health facility treatment registers, patient medical files and face-to-face interviews were used to collect the data and these were captured onto an Excel spreadsheet, cleaned, coded before importation into Epiinfo 17 for statistical analyses. Logistic regression analyses were conducted to investigate the factors associated with virological non-suppression.
    UNASSIGNED: the study found a majority of participants were females (240/401 (60%)). The mean age of the participants was 38.1 (SD=11.2), with most participants who were between the ages of 29 and 39 years old (167 (41.7%)). Virological non-suppression was observed among 10% (40/401) of participants. The odds of virological non-suppression were higher among participants who were married (aOR 4.76, 95% CI 1.49-15.19; p=0.008).
    UNASSIGNED: a virological non-suppression of 10% translates to viral suppression of 90%, which is below the target of UNAIDS 95-95-95 strategy. Hiding and skipping medication indicate how non-disclosure continues to hinder HIV treatment adherence. High odds of virological non-suppression among married participants indicate non-disclosure of the positive HIV status, or lack in spousal support.
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  • 文章类型: Journal Article
    在艾滋病毒感染者(PWH)中使用酒精很常见,可能会对参与艾滋病毒护理产生负面影响。我们评估了酒精使用之间的关系,ART使用,以及乌干达PWH中的病毒抑制。PATH/Ekkubo是一项试验,评估了乌干达四个地区与艾滋病毒护理干预的联系,2015年11月-2021年9月。我们的分析样本包括:(1)来自未参加干预试验的个体的基线数据(先前诊断为HIV+);以及来自对照组的12个月随访数据(新诊断或先前诊断,但不关心)。酒精使用水平使用酒精使用障碍识别测试消费(AUDIT-C)进行分类:无(AUDIT-C=0),低(女性=1-2,男性=1-3),中等(女性=3-5,男性=4-5),高/非常高(6-12)。多变量逻辑回归模型评估了酒精使用,ART使用和病毒抑制(病毒载量<20);我们还按性别分层。在931PWH中,中(OR:0.43[95%CI0.25-0.72])和高/非常高(OR:0.22[95%CI0.11-0.42])的酒精使用水平与接受ART的几率较低相关.在664个子样本中,培养基使用(OR:0.63[95%CI0.41-0.97])与较低的病毒抑制几率相关。然而,当限制使用ART时,这种关联没有统计学意义,提示酒精使用与病毒抑制之间的关系可以通过ART使用来解释。在男性中,高/非常高,在女性中,中等酒精使用水平与接受ART和病毒抑制的几率较低相关.可能需要对使用较高水平酒精的PWH进行干预,以优化乌干达通用测试和治疗策略的好处。
    Alcohol use among people living with HIV (PWH) is common and may negatively affect engagement in HIV care. We evaluated the relationships between alcohol use, ART use, and viral suppression among PWH in Uganda. PATH/Ekkubo was a trial evaluating a linkage to HIV care intervention in four Ugandan districts, Nov 2015-Sept 2021. Our analytical sample included: (1) baseline data from individuals not enrolled in the intervention trial (previously diagnosed HIV+); and 12-month follow-up data from the control group (newly diagnosed or previously diagnosed, but not in care). Level of alcohol use was categorized using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C): none (AUDIT-C = 0), low (women = 1-2, men = 1-3), medium (women = 3-5, men = 4-5), high/very high (6-12). Multivariable logistic regression models evaluated associations between alcohol use, ART use and viral suppression (a viral load of < 20); we also stratified by gender. Among 931 PWH, medium (OR: 0.43 [95% CI 0.25-0.72]) and high/very high (OR: 0.22 [95% CI 0.11-0.42]) levels of alcohol use were associated with lower odds of being on ART. In a sub-sample of 664, medium use (OR: 0.63 [95% CI 0.41-0.97]) was associated with lower odds of viral suppression. However, this association was not statistically significant when restricting to those on ART, suggesting the relationship between alcohol use and viral suppression is explained by ART use. Among men, high/very high, and among women, medium alcohol use levels were associated with lower odds of being on ART and being virally suppressed. Interventions for PWH who use higher levels of alcohol may be needed to optimize the benefits of Uganda\'s Universal Test and Treat strategy.
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