Center for Global Health and Development, Boston University, Boston, Massachusetts, USA.
PLoS Med. 2011 Jul;8(7):e1001056. doi: 10.1371/journal.pmed.1001056. Epub 2011 Jul 19.
Improving the outcomes of HIV/AIDS treatment programs in resource-limited settings requires successful linkage of patients testing positive for HIV to pre-antiretroviral therapy (ART) care and retention in pre-ART care until ART initiation. We conducted a systematic review of pre-ART retention in care in Africa.
We searched PubMed, ISI Web of Knowledge, conference abstracts, and reference lists for reports on the proportion of adult patients retained between any two points between testing positive for HIV and initiating ART in sub-Saharan African HIV/AIDS care programs. Results were categorized as Stage 1 (from HIV testing to receipt of CD4 count results or clinical staging), Stage 2 (from staging to ART eligibility), or Stage 3 (from ART eligibility to ART initiation). Medians (ranges) were reported for the proportions of patients retained in each stage. We identified 28 eligible studies. The median proportion retained in Stage 1 was 59% (35%-88%); Stage 2, 46% (31%-95%); and Stage 3, 68% (14%-84%). Most studies reported on only one stage; none followed a cohort of patients through all three stages. Enrollment criteria, terminology, end points, follow-up, and outcomes varied widely and were often poorly defined, making aggregation of results difficult. Synthesis of findings from multiple studies suggests that fewer than one-third of patients testing positive for HIV and not yet eligible for ART when diagnosed are retained continuously in care, though this estimate should be regarded with caution because of review limitations.
Studies of retention in pre-ART care report substantial loss of patients at every step, starting with patients who do not return for their initial CD4 count results and ending with those who do not initiate ART despite eligibility. Better health information systems that allow patients to be tracked between service delivery points are needed to properly evaluate pre-ART loss to care, and researchers should attempt to standardize the terminology, definitions, and time periods reported.
在资源有限的环境下，改善艾滋病毒/艾滋病治疗方案的结果需要成功地将艾滋病毒检测呈阳性的患者与抗逆转录病毒前护理（ART）联系起来，并在开始 ART 之前保持在预 ART 护理中。我们对非洲的预 ART 保留护理进行了系统评价。
我们在 PubMed、ISI Web of Knowledge、会议摘要和参考文献中搜索了撒哈拉以南非洲艾滋病毒/艾滋病护理计划中从艾滋病毒检测呈阳性到开始接受抗逆转录病毒治疗之间的任何两个点之间保留的成年患者比例的报告。结果分为 3 个阶段：第 1 阶段（从艾滋病毒检测到获得 CD4 计数结果或临床分期）、第 2 阶段（从分期到获得 ART 资格）和第 3 阶段（从获得 ART 资格到开始 ART）。报告了每个阶段保留的患者比例的中位数（范围）。我们确定了 28 项合格的研究。第 1 阶段保留的中位数比例为 59%（35%-88%）；第 2 阶段为 46%（31%-95%）；第 3 阶段为 68%（14%-84%）。大多数研究仅报告了一个阶段；没有一项研究对所有三个阶段的患者进行了随访。纳入标准、术语、终点、随访和结果差异很大，且往往定义不明确，使得结果难以汇总。对多项研究结果的综合分析表明，尽管由于审查限制，应该谨慎对待这一估计，但诊断时尚未符合 ART 条件但检测呈阳性的 HIV 患者中，不到三分之一的患者持续接受护理。需要更好的健康信息系统，以便在服务提供点之间跟踪患者，以正确评估预 ART 护理的损失，研究人员应尝试标准化报告的术语、定义和时间段。
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