利用计算机化的药房跟踪系统识别南非社区艾滋病病毒治疗诊所的失访情况。
Identification of losses to follow-up in a community-based antiretroviral therapy clinic in South Africa using a computerized pharmacy tracking system.
机构信息
The Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
出版信息
BMC Infect Dis. 2010 Nov 15;10:329. doi: 10.1186/1471-2334-10-329.
BACKGROUND
High rates of loss to follow-up (LTFU) are undermining rapidly expanding antiretroviral treatment (ART) services in sub-Saharan Africa. The intelligent dispensing of ART (iDART) is an open-source electronic pharmacy system that provides an efficient means of generating lists of patients who have failed to pick-up medication. We determined the duration of pharmacy delay that optimally identified true LTFU.
METHODS
We conducted a retrospective cross-sectional study of a community-based ART cohort in Cape Town, South Africa. We used iDART to identify groups of patients known to be still enrolled in the cohort on the 1st of April 2008 that had failed to pick-up medication for periods of ≥ 6, ≥ 12, ≥ 18 and ≥ 24 weeks. We defined true LTFU as confirmed failure to pick up medication for 3 months since last attendance. We then assessed short-term and long-term outcomes using a prospectively maintained database and patient records.
RESULTS
On the date of the survey, 2548 patients were registered as receiving ART but of these 85 patients (3.3%) were found to be true LTFU. The numbers of individuals (proportion of the cohort) identified by iDART as having failed to collect medication for periods of ≥ 6, ≥ 12, ≥ 18 and ≥ 24 weeks were 560 (22%), 194 (8%), 117 (5%) and 80 (3%), respectively. The sensitivities of these pharmacy delays for detecting true LTFU were 100%, 100%, 62.4% and 47.1%, respectively. The corresponding specificities were 80.7%, 95.6%, 97.4% and 98.4%. Thus, the optimal delay was ≥ 12 weeks since last attendance at this clinic (equivalent to 8 weeks since medication ran out). Pharmacy delays were also found to be significantly associated with LTFU and death one year later.
CONCLUSIONS
The iDART electronic pharmacy system can be used to detect patients potentially LTFU and who require recall. Using a short a cut-off period was too non-specific for LTFU and would require the tracing of very large numbers of patients. Conversely prolonged delays were too insensitive. Of the periods assessed, a ≥ 12 weeks delay appeared optimal. This system requires prospective evaluation to further refine its utility.
背景
在撒哈拉以南非洲，失访率（LTFU）居高不下，正在破坏迅速扩大的抗逆转录病毒治疗（ART）服务。智能配发抗逆转录病毒药物（iDART）是一个开源电子药房系统，为生成未能取药的患者名单提供了一种有效的手段。我们确定了使药房延迟时间最佳化，以识别真正的失访者的时长。
方法
我们对南非开普敦的一个基于社区的 ART 队列进行了回顾性横断面研究。我们使用 iDART 来确定在 2008 年 4 月 1 日仍被认为是队列中的患者群体，这些患者因未能取药而导致≥6、≥12、≥18 和≥24 周。我们将真正的失访定义为自上次就诊以来 3 个月未能取药。然后，我们使用前瞻性维护的数据库和患者记录来评估短期和长期结果。
结果
在调查之日，有 2548 名患者被登记为接受 ART，但其中 85 名（3.3%）被发现是真正的失访者。iDART 确定因未取药而导致≥6、≥12、≥18 和≥24 周的个体（队列的比例）数量分别为 560（22%）、194（8%）、117（5%）和 80（3%）。这些药房延迟的敏感性分别为 100%、100%、62.4%和 47.1%。相应的特异性分别为 80.7%、95.6%、97.4%和 98.4%。因此，最佳的延迟时间是最后一次就诊后≥12 周（相当于上次取药后 8 周）。药房延迟也与一年后的失访和死亡显著相关。
结论
iDART 电子药房系统可用于检测潜在的失访者和需要召回的患者。使用较短的截止期限对于失访者来说特异性不够，需要追踪大量患者。相反，过长的延迟时间敏感性不够。在所评估的时间段中，≥12 周的延迟时间似乎是最佳的。该系统需要前瞻性评估以进一步完善其效用。
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