Factors associated with confirmed VTF.

Despite large numbers of patients accessing antiretroviral treatment (ART) in Kenya, few studies have explored factors associated with virologic failure in Western Kenya, specifically. We undertook a study in Homa Bay County, Kenya to assess the extent of virologic treatment failure and factors associated with it. This was an observational retrospective study conducted from September 2020 to January 2021. Data were abstracted from the records of patients who had been on ART for at least six months at the time of data collection after systematic sampling stratified by age group at ART initiation (0–14 and 15+ years), using probability proportion to the numbers of patients attending the facility. Confirmed viral treatment failure was defined as viral load ≥1000 copies/ml based on two consecutive viral load measurements after at least three months of enhanced adherence counseling. Data were analyzed using descriptive statistics and Cox regression modeling. Of the 2,007 patients sampled, 160 (8.0%) had confirmed virologic treatment failure. Significantly higher virologic treatment failure rates were identified among male patients 78/830 (9.4%) and children 115/782 (14.7%). Factors associated with virologic treatment failure (VTF), were age 0–14 years, adjusted hazard ratio (AHR) 4.42, (95% Confidence Interval [CI], 3.12, 6.32), experience of treatment side effects AHD: 2.43, (95% CI, 1.76, 3.37), attending level 2/3 health facility, AHR: 1.87, (95% CI: 1.29, 2,72), and history of opportunistic infections (OIs), AHR: 1.81, (95% CI, 1.76, 3.37). Children, attendees of level 2/3 health facilities, patients with a history of OIs, and those experiencing treatment side-effects are at risk of VTF. Increased focus on children and adolescents on screening for drug resistance, administration of and adherence to medication, and on effective information and education on side-effects is critical. Additionally, there is need for increased training and support for health care workers at primary level care facilities.尽管肯尼亚已有大量患者接受抗逆转录病毒治疗（antiretroviral treatment, ART），但目前鲜有研究专门针对肯尼亚西部地区，探索与病毒学失败相关的影响因素。本研究在肯尼亚霍马贝县开展，旨在评估病毒学治疗失败的发生情况及其相关影响因素。本研究为2020年9月至2021年1月期间实施的回顾性观察研究。研究对象为数据采集时已接受ART治疗至少6个月的患者，采用以ART启动时年龄分层（分为0–14岁与15岁及以上两组）、以就诊于各医疗机构的患者数为权重的概率比例抽样方法，从患者病历档案中提取研究数据。确诊病毒学治疗失败的标准为：经至少3个月强化依从性咨询后，两次连续病毒载量检测结果均显示病毒载量≥1000拷贝/毫升。本研究采用描述性统计与Cox回归模型对数据进行分析。在纳入抽样的2007例患者中，160例（8.0%）确诊为病毒学治疗失败。男性患者（78/830，9.4%）与儿童患者（115/782，14.7%）的病毒学治疗失败率显著更高。与病毒学治疗失败（virologic treatment failure, VTF）相关的影响因素包括：0–14岁年龄组（调整后风险比（adjusted hazard ratio, AHR）=4.42，95%置信区间（confidence interval, CI）：3.12~6.32）、出现治疗不良反应（AHR=2.43，95%CI：1.76~3.37）、就诊于二级/三级医疗卫生机构（AHR=1.87，95%CI：1.29~2.72）以及有机会性感染（opportunistic infections, OIs）病史（AHR=1.81，95%CI：1.76~3.37）。儿童患者、二级/三级医疗卫生机构就诊者、有机会性感染病史者以及出现治疗不良反应的患者，均为病毒学治疗失败的高风险人群。研究提示，需进一步加强对儿童与青少年的药物耐药性筛查、药物给药指导与治疗依从性管理，以及不良反应相关的有效健康宣教工作。此外，还需为基层医疗卫生机构的医护人员提供更多培训与支持资源。