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Assessment of HIV viral load monitoring in remote settings in Vietnam - comparing people who inject drugs to the other patients
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 therap...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9942987/ https://www.ncbi.nlm.nih.gov/pubmed/36802388 http://dx.doi.org/10.1371/journal.pone.0281857 |
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author | Lefrancois, Louise H. Nguyen, Binh Thanh Pham, Tram Thi Phuong Le, Nhung Thi Hong Dao, Huyen Thi Thanh Tran, Tram Hong Ngo, Khanh Phuong Tong, Ha Thi Phan, Huong Thi Thu Ait-Ahmed, Mohand Pham, Thang Hong Nguyen, Tuan Anh Taieb, Fabien Madec, Yoann |
author_facet | Lefrancois, Louise H. Nguyen, Binh Thanh Pham, Tram Thi Phuong Le, Nhung Thi Hong Dao, Huyen Thi Thanh Tran, Tram Hong Ngo, Khanh Phuong Tong, Ha Thi Phan, Huong Thi Thu Ait-Ahmed, Mohand Pham, Thang Hong Nguyen, Tuan Anh Taieb, Fabien Madec, Yoann |
author_sort | Lefrancois, Louise H. |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-9942987 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-99429872023-02-22 Assessment of HIV viral load monitoring in remote settings in Vietnam - comparing people who inject drugs to the other patients Lefrancois, Louise H. Nguyen, Binh Thanh Pham, Tram Thi Phuong Le, Nhung Thi Hong Dao, Huyen Thi Thanh Tran, Tram Hong Ngo, Khanh Phuong Tong, Ha Thi Phan, Huong Thi Thu Ait-Ahmed, Mohand Pham, Thang Hong Nguyen, Tuan Anh Taieb, Fabien Madec, Yoann PLoS One Research Article 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. Public Library of Science 2023-02-21 /pmc/articles/PMC9942987/ /pubmed/36802388 http://dx.doi.org/10.1371/journal.pone.0281857 Text en © 2023 Lefrancois et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Lefrancois, Louise H. Nguyen, Binh Thanh Pham, Tram Thi Phuong Le, Nhung Thi Hong Dao, Huyen Thi Thanh Tran, Tram Hong Ngo, Khanh Phuong Tong, Ha Thi Phan, Huong Thi Thu Ait-Ahmed, Mohand Pham, Thang Hong Nguyen, Tuan Anh Taieb, Fabien Madec, Yoann Assessment of HIV viral load monitoring in remote settings in Vietnam - comparing people who inject drugs to the other patients |
title | Assessment of HIV viral load monitoring in remote settings in Vietnam - comparing people who inject drugs to the other patients |
title_full | Assessment of HIV viral load monitoring in remote settings in Vietnam - comparing people who inject drugs to the other patients |
title_fullStr | Assessment of HIV viral load monitoring in remote settings in Vietnam - comparing people who inject drugs to the other patients |
title_full_unstemmed | Assessment of HIV viral load monitoring in remote settings in Vietnam - comparing people who inject drugs to the other patients |
title_short | Assessment of HIV viral load monitoring in remote settings in Vietnam - comparing people who inject drugs to the other patients |
title_sort | assessment of hiv viral load monitoring in remote settings in vietnam - comparing people who inject drugs to the other patients |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9942987/ https://www.ncbi.nlm.nih.gov/pubmed/36802388 http://dx.doi.org/10.1371/journal.pone.0281857 |
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