Department of Epidemiology and Public Health, Umeå International School of Public Health, Umeå University, Umeå, Sweden.
Glob Health Action. 2010 Oct 29;3. doi: 10.3402/gha.v3i0.5398.
The antiretroviral treatment (ART) scale-up service has been a recent development in Ethiopia, but its impact on mortality has not been well investigated. The aim of this study was to assess the early survival outcome of the scale-up service by utilizing routine hospital data.
All adult HIV/AIDS patients who started on antiretroviral treatment in Shashemene and Assela hospitals from January 1, 2006 to May 31, 2006 were included and followed up for 2 years. Data were extracted from standard patient medical registrations. Kaplan-Meier curves were used to estimate survival probability and the Cox proportional hazard model was applied to determine predictors of mortality. Two alterative assumptions (real case and worst case) were made in determining predictors of mortality.
The median age of patients was 33 years and 57% were female. Eighty-five percent had CD4 <200 cells/µL with a median CD4 count of 103 cells/µL. The median survival time was 104.4 weeks. A total of 28 (10.3%) deaths were observed during the 2-year period and 48 patients (18%) were lost to follow up. The majority of deaths occurred in the first 4 months of treatment. In multivariate analysis, 2-year survival was significantly associated with the clinical stage of the disease, baseline hemoglobin, and cotrimoxazole prophylaxis therapy (CPT) at or before ART initiation in both assumptions. The median CD4 count and body weight showed a marked improvement during the first 6 months of treatment, followed by stagnation thereafter.
The study has shown an overall low mortality but a high loss to follow-up rate of the cohort. Advanced clinical stage, anemia, low body weight, and lack of CPT initiation were independent predictors of mortality - but not gender. CPT initiation should be encouraged in routine HIV care services, and patient retention mechanisms have to be strengthened. Stagnation in immunological and weight recovery after the first 6 months should be further investigated. The utilization of routine data should be encouraged in order to facilitate appropriate decision making.
抗逆转录病毒治疗（ART）扩大服务是埃塞俄比亚最近的一项发展，但尚未充分研究其对死亡率的影响。本研究旨在利用常规医院数据评估扩大服务的早期生存结果。
所有于 2006 年 1 月 1 日至 2006 年 5 月 31 日期间在沙舍门和阿塞拉医院开始接受抗逆转录病毒治疗的成年艾滋病毒/艾滋病患者均被纳入并随访 2 年。数据从标准患者医疗登记中提取。Kaplan-Meier 曲线用于估计生存概率，Cox 比例风险模型用于确定死亡率的预测因素。在确定死亡率的预测因素时，做出了两种替代假设（实际病例和最差病例）。
患者的中位年龄为 33 岁，57%为女性。85%的患者 CD4<200 个细胞/µL，中位 CD4 计数为 103 个细胞/µL。中位生存时间为 104.4 周。在 2 年期间共观察到 28 例（10.3%）死亡，48 例（18%）失访。大多数死亡发生在治疗的前 4 个月。在多变量分析中，在两种假设下，疾病临床分期、基线血红蛋白和抗逆转录病毒治疗前或开始时的复方新诺明预防疗法（CPT）均与 2 年生存率显著相关。在治疗的前 6 个月中，中位 CD4 计数和体重明显改善，此后停滞不前。
该研究显示，总体死亡率较低，但该队列的失访率较高。晚期临床分期、贫血、低体重和缺乏 CPT 启动是死亡率的独立预测因素，但与性别无关。应鼓励在常规艾滋病毒护理服务中启动 CPT，必须加强患者保留机制。在第 6 个月后免疫和体重恢复停滞不前的情况应进一步调查。应鼓励利用常规数据以促进做出适当的决策。
