McCarthy K, Chersich M F, Vearey J, Meyer-Rath G, Jaffer A, Simpwalo S, Venter W D F
Reproductive Health and HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Int J STD AIDS. 2009 Dec;20(12):858-62. doi: 10.1258/ijsa.2009.009258.
Foreigners, including displaced persons, often have limited health-care access, especially to HIV services. Outcomes of antiretroviral therapy (ART) in South Africans and foreigners were compared at a Johannesburg non-governmental clinic. Records were reviewed of 1297 adults enrolled between April 2004 and March 2007 (568 self-identified foreigners, 431 South Africans citizens and 298 with unknown origin). Compared with citizens, foreigners had fewer hospital admissions (39%, 90/303 versus 51%, 126/244; P < 0.001), less missed appointments for ART initiation (20%, 39/200 versus 25%, 51/206; P < 0.001), faster median time to ART initiation (14 versus 21 days, P = 0.008), better retention in care (88%, 325/369 versus 69%, 155/226; P < 0.001) and lower mortality (2.5%, 14/568 versus 10%, 44/431; P < 0.001) after 426 person-years. In logistic regression, after controlling for baseline CD4 count and tuberculosis status, foreigners were 55% less likely to fail ART than citizens (95% CI = 0.23-0.87). These findings support United Nations High Commissioner for Refugees recommendations that ART should not be withheld from displaced persons.
包括流离失所者在内的外国人往往获得医疗保健的机会有限，尤其是获得艾滋病毒服务的机会。在约翰内斯堡的一家非政府诊所，对南非人和外国人接受抗逆转录病毒疗法（ART）的结果进行了比较。回顾了2004年4月至2007年3月期间登记的1297名成年人的记录（568名自称外国人、431名南非公民和298名来源不明者）。与公民相比，外国人住院次数较少（39%，90/303对51%，126/244；P<0.001），开始接受抗逆转录病毒治疗时错过预约的情况较少（20%，39/200对25%，51/206；P<0.001），开始接受抗逆转录病毒治疗的中位时间更快（14天对21天，P=0.008），护理留存率更高（88%，325/369对69%，155/226；P<0.001），426人年之后死亡率更低（2.5%，14/568对10%，44/431；P<0.001）。在逻辑回归中，在控制基线CD4细胞计数和结核病状况后，外国人抗逆转录病毒治疗失败的可能性比公民低55%（95%CI=0.23-0.87）。这些发现支持了联合国难民事务高级专员的建议，即不应拒绝对流离失所者提供抗逆转录病毒治疗。
