Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
AIDS. 2010 Nov 13;24(17):2665-78. doi: 10.1097/QAD.0b013e32833f4b1b.
A 'test and treat' strategy to reduce HIV transmission hinges on linking and retaining HIV patients in care to achieve the full benefit of antiretroviral therapy. We integrated empirical findings and estimated the percentage of HIV-positive persons in the United States who entered HIV medical care soon after their diagnosis; and were retained in care during specified assessment intervals.
We comprehensively searched databases and bibliographic lists to identify studies that collected data from May 1995 through 2009. Separate meta-analyses were conducted for entry into care and retention in care (having multiple HIV medical visits during specified assessment intervals) stratified by methodological variables. All analyses used random-effects models.
Overall, 69% [95% confidence interval (CI) 66-71%, N = 53 323, 28 findings] of HIV-diagnosed persons in the United States entered HIV medical care averaged across time intervals in the studies. Seventy-two percent (95% CI 67-77%, N = 6586, 12 findings) entered care within 4 months of diagnosis. Seventy-six percent (95% CI 66-84%, N = 561, 15 findings) entered care after testing HIV-positive in emergency/urgent care departments and 67% (95% CI 64-70%, N = 52 762, 13 findings) entered care when testing was done in community locations. With respect to retention in care, 59% (95% CI 53-65%, N = 75 655, 28 findings) had multiple HIV medical care visits averaged across assessment intervals of 6 months to 3-5 years. Retention was lower during longer assessment intervals.
Entry and retention in HIV medical care in the United States are moderately high. Improvement in both outcomes will increase the success of a test and treat strategy.
通过“检测即治疗”策略来减少 HIV 传播，关键在于将 HIV 患者及时联系并纳入到治疗中，以充分发挥抗逆转录病毒疗法的作用。我们综合了现有的实证研究结果，估算了美国新诊断 HIV 阳性患者中在诊断后不久即进入 HIV 医疗保健系统并在特定评估间隔期间得到保留的比例。
我们全面检索了数据库和参考文献列表，以确定从 1995 年 5 月至 2009 年期间收集数据的研究。根据方法学变量，分别对进入医疗保健系统和保留在医疗保健系统（在特定评估间隔期间有多次 HIV 医疗就诊）进行了荟萃分析。所有分析均采用随机效应模型。
总体而言，在美国，新诊断 HIV 患者中有 69%（95%置信区间[CI]66-71%，N=53323，28 项研究）在研究中的各个时间间隔内进入 HIV 医疗保健系统。72%（95%CI67-77%，N=6586，12 项研究）在诊断后 4 个月内就诊。76%（95%CI66-84%，N=561，15 项研究）在急症/紧急护理部门 HIV 检测阳性后就诊，67%（95%CI64-70%，N=52762，13 项研究）在社区场所进行 HIV 检测时就诊。在保留医疗保健系统方面，59%（95%CI53-65%，N=75655，28 项研究）在 6 个月至 3-5 年的评估间隔期间有多次 HIV 医疗就诊。随着评估间隔时间的延长，保留比例降低。
美国 HIV 医疗保健系统的进入和保留率中等偏高。改善这两个结果将提高“检测即治疗”策略的成功率。
