Thai Sopheak, Koole Olivier, Un Phally, Ros Seilavath, De Munter Paul, Van Damme Wim, Jacques Gary, Colebunders Robert, Lynen Lutgarde
Infectious Disease Department, Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.
Trop Med Int Health. 2009 Sep;14(9):1048-58. doi: 10.1111/j.1365-3156.2009.02334.x. Epub 2009 Jul 2.
To evaluate a 5-year HIV care programme (2003-2007) in the Sihanouk Hospital Center of HOPE, Phnom Penh, Cambodia.
Analysis of routine programme indicators per year: number of new patients, active patients, antiretroviral therapy (ART) coverage in the cohort, mortality and loss to follow-up. Comparison of mortality before and after the start of ART using Kaplan-Meier survival curves. Analysis of risk factors using Cox regression for the combined endpoint of mortality and loss to follow-up in patients on ART.
3844 patients were registered in the hospital between March 2003 and December 2007. The mortality and loss to follow-up rate fell and paralleled the rise of ART coverage from 23% in 2003 to 90% in 2007. The mortality and the loss to follow-up rate was significantly higher in patients not on ART but eligible (Log rank P < 0.001). The combined endpoint of mortality and loss to follow-up was 48.7% after one year in patients who were waiting for ART. 1667 patients were started on ART. The combined endpoint (mortality and loss to follow-up) in this group was 11.5% at 12 months and 14.2% at 24 months. Risk factors for mortality in the ART group were male sex, CD4 count <50 cells/microl, BMI <18 and haemoglobin levels <10 g/dl.
Better access to ART is associated with lower mortality and fewer losses to follow-up. Pre-ART attrition remains significant. Strategies are needed to enable an earlier start of ART and to promote retention in care.
评估柬埔寨金边希望之城西哈努克医院中心在2003年至2007年期间实施的一项为期5年的艾滋病护理项目。
每年分析常规项目指标：新患者数量、现患患者数量、队列中抗逆转录病毒疗法（ART）覆盖率、死亡率和失访率。使用Kaplan-Meier生存曲线比较ART开始前后的死亡率。对接受ART治疗患者的死亡率和失访这一联合终点，采用Cox回归分析危险因素。
2003年3月至2007年12月期间，该医院登记了3844例患者。死亡率和失访率下降，且与ART覆盖率从2003年的23%上升至2007年的90%相平行。未接受ART但符合条件的患者的死亡率和失访率显著更高（对数秩检验P<0.001）。等待ART治疗的患者在1年后，死亡率和失访这一联合终点为48.7%。1667例患者开始接受ART治疗。该组在12个月时的联合终点（死亡率和失访率）为11.5%，在24个月时为14.2%。接受ART治疗组的死亡危险因素为男性、CD4细胞计数<50个/微升、体重指数<18以及血红蛋白水平<10克/分升。
更好地获得ART治疗与更低的死亡率和更少的失访相关。ART治疗前的损耗仍然很大。需要采取策略以更早开始ART治疗并促进患者坚持治疗。
