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Factors associated with unsuppressed viremia in women living with HIV on lifelong ART in the multi-country US-PEPFAR PROMOTE study: A cross-sectional analysis.
Atuhaire, Patience; Hanley, Sherika; Yende-Zuma, Nonhlanhla; Aizire, Jim; Stranix-Chibanda, Lynda; Makanani, Bonus; Milala, Beteniko; Cassim, Haseena; Taha, Taha; Fowler, Mary Glenn.
Afiliação
  • Atuhaire P; Makerere University-Johns Hopkins University (MU-JHU) Kampala, Uganda.
  • Hanley S; Centre for the AIDS Programme of Research in South Africa (CAPRISA), Umlazi Clinical Research Site, Nelson R. Mandela School of Medicine, Durban, South Africa.
  • Yende-Zuma N; Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.
  • Aizire J; Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States of America.
  • Stranix-Chibanda L; University of Zimbabwe College of Health Sciences Department of Paediatrics and Child Health, Harare, Zimbabwe.
  • Makanani B; Malawi College of Medicine-John's Hopkins Research Project, Blantyre, Malawi.
  • Milala B; University of North Carolina (UNC) Project, Lilongwe, Malawi.
  • Cassim H; Perinatal HIV Research Unit (PHRU), Chris Hani Baragwanath Hospital, University of Witwatersrand, Johannesburg, South Africa.
  • Taha T; Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States of America.
  • Fowler MG; Johns Hopkins University, Departments of Pathology and Epidemiology, Baltimore, MD, United States of America.
PLoS One ; 14(10): e0219415, 2019.
Article em En | MEDLINE | ID: mdl-31647806
BACKGROUND: Despite recent efforts to scale-up lifelong combination antiretroviral therapy (cART) in sub-Saharan Africa, high rates of unsuppressed viremia persist among cART users, and many countries in the region fall short of the UNAIDS 2020 target to have 90% virally suppressed. We sought to determine the factors associated with unsuppressed viremia (defined for the purpose of this study as >200 copies/ml) among sub-Saharan African women on lifelong cART. METHODS: This cross-sectional analysis was based on baseline data of the PROMOTE longitudinal cohort study at 8 sites in Uganda, Malawi, Zimbabwe and South Africa. The study enrolled 1987 women living with HIV who initiated lifelong cART at least 1-5 years ago. Socio-demographic, clinical, and cART adherence data were collected. We used multivariable Poisson regression with robust variance to identify factors associated with unsuppressed viremia. RESULTS: At enrolment, 1947/1987 (98%) women reported taking cART. Of these, HIV-1 remained detectable in 293/1934 (15%), while 216/1934 (11.2%) were considered unsuppressed (>200 copies/ml). The following factors were associated with an increased risk of unsuppressed viremia: not having household electricity (adjusted prevalence risk ratio (aPRR) 1.74, 95% confidence interval (CI) 1.28-2.36, p<0.001); not being married (aPRR 1.32, 95% CI 0.99-1.78, p = 0.061), self-reported missed cART doses (aPRR 1.63, 95% CI 1.24-2.13, p<0.001); recent hospitalization (aPRR 2.48, 95% CI 1.28-4.80, p = 0.007) and experiencing abnormal vaginal discharge in the last three months (aPRR 1.88; 95% CI 1.16-3.04, p = 0.010). Longer time on cART (aPRR 0.75, 95% CI 0.64-0.88, p<0.001) and being older (aPRR 0.77, 95% CI 0.76-0.88, p<0.001) were associated with reduced risk of unsuppressed viremia. CONCLUSION: Socioeconomic barriers such as poverty, and individual barriers like not being married, young age, and self-reported missed doses are key predictors of unsuppressed viremia. Targeted interventions are needed to improve cART adherence among women living with HIV with this risk factor profile.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Viremia / Infecções por HIV / HIV-1 / Antirretrovirais Tipo de estudo: Clinical_trials / Etiology_studies / Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: Africa Idioma: En Revista: PLoS One Assunto da revista: CIENCIA / MEDICINA Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Uganda

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Viremia / Infecções por HIV / HIV-1 / Antirretrovirais Tipo de estudo: Clinical_trials / Etiology_studies / Observational_studies / Prevalence_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: Africa Idioma: En Revista: PLoS One Assunto da revista: CIENCIA / MEDICINA Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Uganda