Assessment of HIV viral load monitoring in remote settings in Vietnam - comparing people who inject drugs to the other patients.

Autor: Lefrancois LH; Epidemiology of Emerging Diseases, Institut Pasteur, Université de Paris, Paris, France., Nguyen BT; National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam., Pham TTP; National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam., Le NTH; National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam., Dao HTT; National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam., Tran TH; National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam., Ngo KP; Training and Research Management Center, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam., Tong HT; Training and Research Management Center, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam., Phan HTT; Vietnam Administration of HIV/AIDS Control, Ministry of Health, Hanoi, Vietnam., Ait-Ahmed M; Center for Translational Research, Institut Pasteur, Université de Paris, Paris, France., Pham TH; National Reference Laboratory of HIV Molecular Biology, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam.; HIV/AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam., Nguyen TA; HIV/AIDS Department, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam., Taieb F; Center for Translational Research, Institut Pasteur, Université de Paris, Paris, France.; Department of International Affairs, Institut Pasteur, Université de Paris, Paris, France., Madec Y; Epidemiology of Emerging Diseases, Institut Pasteur, Université de Paris, Paris, France.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2023 Feb 21; Vol. 18 (2), pp. e0281857. Date of Electronic Publication: 2023 Feb 21 (Print Publication: 2023).
DOI: 10.1371/journal.pone.0281857
Abstrakt: Introduction: Increasing access to viral load (VL) monitoring is essential to fight HIV epidemics. In remote settings in Vietnam, using dried blood spot (DBS) sampling for specimen collection could improve the situation. Here, people who inject drugs (PWID) represent many newly antiretroviral therapy (ART)-initiated patients. The goals of this evaluation were to evaluate if access to VL monitoring and the rate of virological failure differed between PWID and non-PWID.
Methods: Prospective cohort study of patients newly initiated on ART in remote settings in Vietnam. DBS coverage at 6, 12 and 24 months of ART was investigated. Factors associated with DBS coverage were identified through logistic regression, as were factors associated with virological failure (VL ≥1,000 copies/mL) at 6, 12 and 24 months of ART.
Results: Overall 578 patients were enrolled in the cohort, of whom 261 (45%) were PWID. DBS coverage improved from 74.7% to 82.9% between 6 and 24 months of ART (p = 0.001). PWID status was not associated with DBS coverage (p = 0.74), but DBS coverage was lower in patients who were late to clinical visits and in those in WHO stage 4 (p = 0.023 and p = 0.001, respectively). The virological failure rate decreased from 15.8% to 6.6% between 6 and 24 months of ART (p<0.001). In multivariate analysis, PWID were more at risk of failure (p = 0.001), as were patients who were late to clinical visits (p<0.001) and not fully adherent (p<0.001).
Conclusions: Despite training and simple procedures, DBS coverage was not perfect. DBS coverage was not associated with PWID status. Close management is required for effective routine HIV VL monitoring. PWID were more at risk of failure, as were patients who were not fully adherent and patients who were late to clinical visits. Specific interventions targeting these patients are needed to improve their outcomes. Overall, efforts in coordination and communication are essential to improve global HIV care.
Trial Registration: Clinical Trial Number: NCT03249493.
Competing Interests: All authors report no conflict of interest.
(Copyright: © 2023 Lefrancois et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
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