INSERM, U897, and ISPED, Université Bordeaux 2, Bordeaux, France.
Trop Med Int Health. 2010 Jun;15 Suppl 1(Suppl 1):34-42. doi: 10.1111/j.1365-3156.2010.02505.x.
To study factors associated with the probability of retention in antiretroviral therapy (ART) programmes in West Africa.
The International epidemiologic Databases to Evaluate AIDS (IeDEA) in West Africa is a prospective, operational, observational cohort study based on collaboration between 11 cohorts of HIV-infected adult patients in Benin, Côte d'Ivoire, Gambia, Mali and Senegal. All patients aged 16 and older at ART initiation, with documented gender and date of ART initiation, were included. For those with at least 1 day of follow-up, Kaplan-Meier method and Weibull regression model were used to estimate the 12-month probability of retention in care and the associated factors.
In this data merger, 14 352 patients (61% female) on ART were included. Median age was 37 (interquartile range (IQR): 31-44 years) and median CD4 count at baseline was 131 cells/mm(3) (IQR: 48-221 cells/mm(3)). The first-line regimen was NNRTI-based for 78% of patients, protease inhibitor-based for 17%, and three NRTIs for 3%. The probability of retention was 0.90 [95% confidence interval (CI): 0.89-0.90] at 3 months, 0.84 (95% CI: 0.83-0.85) at 6 months and 0.76 (95% CI: 0.75-0.77) at 12 months. The probability of retention in care was lower in patients with baseline CD4 count <50 cells/mm(3) [adjusted hazard ratio (aHR) = 1.37; 95% CI: 1.27-1.49; P < 0.0001] (reference CD4 > 200 cells/mm(3), in men (aHR = 1.17; 95% CI: 1.10-1.24; P = 0.0002), in younger patients (<30 years) (aHR = 1.10; 95% CI: 1.03-1.19; P = 0.01) and in patients with low haemoglobinaemia <8 g/dl (aHR = 1.33; 95% CI: 1.21-1.45; P < 0.0001). Availability of funds for systematic tracing was associated with better retention (aHR = 0.29; 95% CI: 0.16-0.55; P = 0.001).
Close follow-up, promoting early access to care and ART and a decentralized system of care may improve the retention in care of HIV-infected patients on ART.
研究与西非抗逆转录病毒疗法（ART）项目保留率相关的因素。
国际艾滋病流行病学数据库（IeDEA）在西非是一个基于合作的前瞻性、操作性、观察性队列研究，由贝宁、科特迪瓦、冈比亚、马里和塞内加尔的 11 个艾滋病毒感染成年患者队列组成。所有在开始接受 ART 时年龄在 16 岁及以上，且有记录的性别和开始接受 ART 的日期的患者均被纳入。对于那些至少有 1 天随访的患者，使用 Kaplan-Meier 方法和威布尔回归模型来估计 12 个月的保留率和相关因素。
在本次数据合并中，有 14 352 名（61%为女性）接受 ART 的患者被纳入。中位年龄为 37 岁（四分位距（IQR）：31-44 岁），基线时 CD4 计数中位数为 131 个细胞/mm³（IQR：48-221 个细胞/mm³）。一线方案中，78%的患者使用 NNRTI 为基础，17%的患者使用蛋白酶抑制剂为基础，3%的患者使用三种 NRTIs。3 个月时保留率为 0.90[95%置信区间（CI）：0.89-0.90]，6 个月时为 0.84（95%CI：0.83-0.85），12 个月时为 0.76（95%CI：0.75-0.77）。基线 CD4 计数<50 个细胞/mm³的患者保留率较低（调整后的危险比[aHR] = 1.37；95%CI：1.27-1.49；P < 0.0001）（参考 CD4 > 200 个细胞/mm³，男性为 aHR = 1.17；95%CI：1.10-1.24；P = 0.0002）、年轻患者（<30 岁）为 aHR = 1.10；95%CI：1.03-1.19；P = 0.01）和低血红蛋白血症<8 g/dl 的患者为 aHR = 1.33（95%CI：1.21-1.45；P < 0.0001）。有系统追踪资金的患者保留率更好（aHR = 0.29；95%CI：0.16-0.55；P = 0.001）。
密切监测、促进早期获得治疗和 ART 以及分散的护理系统可能会提高接受 ART 的艾滋病毒感染者的保留率。
