RESUMO
OBJECTIVE: Kenya ART guidelines recommend three sessions of enhanced adherence counselling (EAC) following detectable viral load. The objective of this study was to assess completion of EAC sessions and factors associated with viral re-suppression amongst adolescents and young persons (AYPs) with persistent viremia in Western Kenya. METHODS: A retrospective analysis of routinely collected data abstracted from viral load registers was done. AYP with persistent viremia (consecutive viral load ≥1000âcopies/ml) between October 2017 to September 2019 were followed for 12âmonths; those with more than one follow-up viral load results were analyzed. EAC was satisfactory if at least three sessions attended, barriers identified and addressed. Morisky scores 0 and at least 1 indicated optimal and sub-optimal adherence, respectively. Logistic regression models were used to assess predictors of viral load suppression (VLS). RESULTS: Of 124 AYPs with persistent viremia, 118 (95.2%) had documented follow-up viral load results and 119 (96%) completed three EAC sessions. Overall, 55 (47%) clients re-suppressed during the study period. AYPs who had satisfactory EAC sessions had higher odds of achieving VLS [odds ratio (OR)â=â3.7, 95% confidence interval (CI): 1.6-8.1]. Similarly, AYPs with an optimal adherence had eight times (ORâ=â8.1, 95% CI: 3.5-18.5) higher odds of achieving VLS, and those who were suppressed at 6âmonths post-ART initiation had higher odds of achieving VLS at 12-months (ORâ=â2.5, 95% CI: 1.1-5.8). CONCLUSION: Satisfactory EAC sessions and optimal ART adherence was strongly associated with viral re-suppression among AYPs with persistent viremia. Continued support to EAC intervention is critical to improve treatment outcome among AYP living with HIV.
Assuntos
Aconselhamento , Infecções por HIV , Adesão à Medicação , Carga Viral , Viremia , Humanos , Adolescente , Masculino , Feminino , Estudos Retrospectivos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Adesão à Medicação/estatística & dados numéricos , Adulto Jovem , Quênia , Adulto , Resultado do Tratamento , Resposta Viral Sustentada , Fármacos Anti-HIV/uso terapêuticoRESUMO
BACKGROUND: In Kenya, of the 82,000 children living with HIV, only 59% are receiving ART and 67% are virally suppressed. Early in the COVID-19 pandemic, the Ministry of Health recommended 3 multimonth dispensing (3MMD) of ART to all people living with HIV, including children. This study assesses the association between 3 MMD and clinical outcomes among children in Western Kenya. SETTINGS: and Methods: We conducted a retrospective cohort study using routinely collected deidentified patient-level data from 43 facilities in Kisii and Migori Counties. The study included children aged 2-9 years who had been previously initiated on ART and sought HIV services between March 01, 2020, and March 30, 2021. We used generalized linear models with Poisson regression models to assess the association between MMD on retention at 6 months and viral suppression (<1000 copies/mL). RESULTS: Among the 963 children, 65.2% were aged 5-9 years and 50.7% were female patients. Seventy-eight percent received 3MMD at least once during the study period. Children who received 3MMD were 12% (adjusted risk ratio [aRR] 1.12, 95% CI: 1.01 to 1.24) more likely to be retained and 22% (aRR 1.22, 1.12 to 1.34) more likely to be virally suppressed than those on <3MMD. When stratified by viral suppression at entry, the association between 3MMD and retention (aRR 1.22, 95% CI: 1.02 to 1.46) and viral suppression (aRR 1.76, 95% CI: 1.30-2.37) was significant among individuals who were unsuppressed at baseline. CONCLUSIONS: 3MMD was associated with comparable or improved HIV health outcomes among children.