Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America.
PLoS One. 2010 Mar 4;5(3):e9538. doi: 10.1371/journal.pone.0009538.
Although loss to follow-up after antiretroviral therapy (ART) initiation is increasingly recognized, little is known about pre-treatment losses to care (PTLC) after an initial positive HIV test. Our objective was to determine PTLC in newly identified HIV-infected individuals in South Africa.
METHODOLOGY/PRINCIPAL FINDINGS: We assembled the South African Test, Identify and Link (STIAL) Cohort of persons presenting for HIV testing at two sites offering HIV and CD4 count testing and HIV care in Durban, South Africa. We defined PTLC as failure to have a CD4 count within 8 weeks of HIV diagnosis. We performed multivariate analysis to identify factors associated with PTLC. From November 2006 to May 2007, of 712 persons who underwent HIV testing and received their test result, 454 (64%) were HIV-positive. Of those, 206 (45%) had PTLC. Infected patients were significantly more likely to have PTLC if they lived > or = 10 kilometers from the testing center (RR = 1.37; 95% CI: 1.11-1.71), had a history of tuberculosis treatment (RR = 1.26; 95% CI: 1.00-1.58), or were referred for testing by a health care provider rather than self-referred (RR = 1.61; 95% CI: 1.22-2.13). Patients with one, two or three of these risks for PTLC were 1.88, 2.50 and 3.84 times more likely to have PTLC compared to those with no risk factors.
CONCLUSIONS/SIGNIFICANCE: Nearly half of HIV-infected persons at two high prevalence sites in Durban, South Africa, failed to have CD4 counts following HIV diagnosis. These high rates of pre-treatment loss to care highlight the urgent need to improve rates of linkage to HIV care after an initial positive HIV test.
尽管人们越来越认识到抗逆转录病毒疗法（ART）启动后的失访问题，但对于初始 HIV 检测阳性后护理的提前流失（PTLC）却知之甚少。我们的目的是确定南非新确诊的 HIV 感染者中的 PTLC。
方法/主要发现：我们组建了南非测试、识别和联系（STIAL）队列，该队列由在南非德班的两个提供 HIV 和 CD4 计数检测以及 HIV 护理的地点进行 HIV 检测的人组成。我们将 PTLC 定义为在 HIV 诊断后 8 周内未能进行 CD4 计数。我们进行了多变量分析以确定与 PTLC 相关的因素。从 2006 年 11 月至 2007 年 5 月，在接受 HIV 检测并收到检测结果的 712 人中，有 454 人（64%）HIV 阳性。其中，206 人（45%）存在 PTLC。如果感染患者居住在距离检测中心≥10 公里处（RR=1.37；95%CI：1.11-1.71）、有结核病治疗史（RR=1.26；95%CI：1.00-1.58）或由医疗保健提供者而不是自行转诊进行检测（RR=1.61；95%CI：1.22-2.13），则更有可能出现 PTLC。与没有风险因素的患者相比，具有这些 PTLC 风险因素之一、二或三的患者出现 PTLC 的可能性分别增加了 1.88、2.50 和 3.84 倍。
结论/意义：在南非德班两个高流行地区的两个高流行地区，近一半的 HIV 感染者在 HIV 诊断后未能进行 CD4 计数。这些高比例的治疗前护理流失突出表明，迫切需要提高初始 HIV 检测阳性后与 HIV 护理的联系率。
