Magnitude and Determinants of Virological Failure Among Patients >15 Years on Anti-Retroviral Therapy in Rural Lesotho Between 2015 and 2019 - A Retrospective Cohort Study.

IF 1.5 Q4 INFECTIOUS DISEASES HIV AIDS-Research and Palliative Care Pub Date : 2023-10-11 eCollection Date: 2023-01-01 DOI:10.2147/HIV.S424277
Thabo Ishmael Lejone, Ozayr Mahomed
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Abstract

Background: Lesotho has the second-highest HIV prevalence globally at an estimated 23%, with approximately 87% of the population between 15 and 59 years of age reported to be receiving antiretroviral treatment. There is an urgent need to increase access to effective ART due to increasing rates of first- and second-line treatment failure. Sustaining successful treatment and limiting the development of virological failure is essential, hence the need for early detection of increased viral load indicating drug resistance or rapid progression of viral replication.

Aim: The aim of the study was to determine the proportion of patients with HIV with virological failure and to identify factors associated with virological failure in two districts of Lesotho.

Methods: A retrospective cohort study was conducted in two districts (Butha-Buthe and Mokhotlong) in Lesotho. Data for all patients (age ≥15 years) in the viral load (VL) monitoring database with at least two consecutive viral load results between December 2015 and December 2019 from 22 health facilities were extracted. Descriptive data were presented using tables and figures. Bivariate and multivariate analyses were performed. A p-value < 0.05 was considered a statistically significant association.

Results: Only 4% (n = 913) of the study participants had virological failure. Longer time on treatment >65 months (AOR: 1.85 CI: 1.59-2.15) and being on second-line ART regimen (AOR: 75.23 95% CI: 75.00-99.15) were significantly (p < 0.001) associated with virological failure.

Conclusion: Virological failure among the study participants is lower compared to other settings. The study identified duration on treatment, treatment regimen as high risk for virological failure. Targeted interventions should be developed for these high-risk group individuals, with continuous monitoring of virological response and appropriate drug switching to clients to achieve improved outcomes.

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2015年至2019年间,莱索托农村接受抗逆转录病毒治疗超过15年的患者病毒学失败的程度和决定因素——一项回顾性队列研究。
背景:莱索托是全球艾滋病毒感染率第二高的国家,估计为23%,据报道,15至59岁的人口中约有87%正在接受抗逆转录病毒治疗。由于一线和二线治疗失败率的增加,迫切需要增加获得有效抗逆转录病毒疗法的机会。维持成功的治疗并限制病毒学失败的发展是至关重要的,因此需要早期检测表明耐药性或病毒复制快速进展的病毒载量增加。目的:本研究的目的是确定莱索托两个地区艾滋病毒感染者病毒学失败的比例,并确定与病毒学失败相关的因素。方法:在莱索托的两个地区(Butha Buthe和Mokhotlong)进行回顾性队列研究。提取了病毒载量(VL)监测数据库中所有患者(年龄≥15岁)的数据,这些患者在2015年12月至2019年12月期间至少有两次来自22个卫生机构的连续病毒载量结果。描述性数据以表格和图表的形式呈现。进行了双变量和多变量分析。p值<0.05被认为是具有统计学意义的关联。结果:只有4%(n=913)的研究参与者出现病毒学失败。治疗时间>65个月(AOR:1.85 CI:1.59-2.15)和接受二线抗逆转录病毒疗法(AOR:75.23 95%CI:7500-99.15)与病毒学失败显著相关(p<0.001)。结论:与其他环境相比,研究参与者的病毒学失败率较低。该研究确定治疗持续时间和治疗方案是病毒学失败的高风险。应为这些高危人群制定有针对性的干预措施,持续监测病毒学反应,并向客户提供适当的药物,以改善结果。
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来源期刊
CiteScore
3.00
自引率
6.70%
发文量
61
审稿时长
16 weeks
期刊介绍: About Dove Medical Press Dove Medical Press Ltd is part of Taylor & Francis Group, the Academic Publishing Division of Informa PLC. We specialize in the publication of Open Access peer-reviewed journals across the broad spectrum of science, technology and especially medicine. Dove Medical Press was founded in 2003 with the objective of combining the highest editorial standards with the ''best of breed'' new publishing technologies. We have offices in Manchester and London in the United Kingdom, representatives in Princeton, New Jersey in the United States, and our editorial offices are in Auckland, New Zealand. Dr Scott Fraser is our Medical Director based in the UK. He has been in full time clinical practice for over 20 years as well as having an active research interest.
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