Lowrance David W, Ndamage Francois, Kayirangwa Eugenie, Ndagije Felix, Lo Wilson, Hoover Donald R, Hanson Jeff, Elul Batya, Ayaba Aliou, Ellerbrock Tedd, Rukundo Alphonse, Shumbusho Fabienne, Nash Denis, Mugabo Jules, Assimwe Anita
Global AIDS Program, US Centers for Disease Control and Prevention, Kigali, Rwanda.
J Acquir Immune Defic Syndr. 2009 Sep 1;52(1):49-55. doi: 10.1097/QAI.0b013e3181b03316.
By December 2007, over 48,000 persons had initiated antiretroviral treatment (ART) at 171 clinics in Rwanda. Assessing national ART program outcomes is essential to determine whether programs have the desired impact.
We conducted a retrospective cohort study to assess key 6- and 12-month outcomes among a nationally representative, stratified, random sample of 3194 adults (> or =15 years) who initiated ART from January 1, 2004, through December 31, 2005.
At ART initiation, the median patient age was 37 years and 65% were female. Overall, the baseline median CD4 cell count was 141 cells per microliter. At 6 and 12 months after ART initiation, 92% and 86% of patients, respectively, remained on ART at their original site. By 6 months, 3.6% were dead and 3.4% were lost to follow-up; by 12 months, 4.6% were dead and 4.9% were lost to follow-up. Among patients with available follow-up CD4 cell count data, median CD4 cell counts increased by 98 cells per microliter and 119 cells per microliter at 6 and 12 months after ART initiation, respectively.
Rwanda's national ART program achieved excellent 6- and 12-month retention and immunologic outcomes during the first 2 years of rapid scale-up. Routine supervision is required to improve compliance with clinical guidelines and data quality.
到2007年12月，超过48000人在卢旺达的171家诊所开始接受抗逆转录病毒治疗（ART）。评估国家ART项目的成果对于确定项目是否产生预期影响至关重要。
我们进行了一项回顾性队列研究，以评估2004年1月1日至2005年12月31日期间开始接受ART治疗的3194名成年人（≥15岁）的全国代表性分层随机样本中的关键6个月和12个月结局。
开始接受ART治疗时，患者的中位年龄为37岁，65%为女性。总体而言，基线CD4细胞计数中位数为每微升141个细胞。在开始接受ART治疗后的6个月和12个月时，分别有92%和86%的患者仍在原治疗地点接受ART治疗。到6个月时，3.6%的患者死亡，3.4%的患者失访；到12个月时，4.6%的患者死亡，4.9%的患者失访。在有可用随访CD4细胞计数数据的患者中，开始接受ART治疗后的6个月和12个月时，CD4细胞计数中位数分别增加了每微升98个细胞和119个细胞。
卢旺达的国家ART项目在快速扩大规模的头两年中，在6个月和12个月的留存率及免疫结局方面取得了优异成绩。需要进行常规监督以提高对临床指南的依从性和数据质量。
