Division of International and Environmental Health, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
J Acquir Immune Defic Syndr. 2012 Feb 1;59(2):e9-16. doi: 10.1097/QAI.0b013e31823edb6a.
Data on outcomes of antiretroviral treatment (ART) programs in rural sub-Saharan African are scarce. We describe early losses and long-term outcomes in 6 rural programs in Southern Africa with limited access to viral load monitoring and second-line ART.
Patients aged ≥16 years starting ART in 2 programs each in Zimbabwe, Mozambique, and Lesotho were included. We evaluated risk factors for no follow-up after starting ART and mortality and loss to follow-up (LTFU) over 3 years of ART, using logistic regression and competing risk models. Odds ratios and subdistribution hazard ratios, adjusted for gender, age category, CD4 category, and World Health Organization stage at start of ART are reported.
Among 7725 patients, 449 (5.8%) did not return after initiation of ART. During 9575 person-years, 698 (9.6%) of those with at least 1 follow-up visit died, and 1319 (18.1%) were LTFU. At 3 years, the cumulative incidence of death and LTFU were 12.5% (11.5%-13.5%) and 25.4% (24.0%-26.9%), respectively, with important differences between countries as follows: in Zimbabwe 75.1% (72.8%-77.3%) were alive and on ART at 3 years compared with 55.4% (52.8%-58.0%) in Lesotho and 51.6% (48.0%-55.2%) in Mozambique. In all settings, young age and male gender predicted LTFU, whereas advanced clinical stage and low baseline CD4 counts predicted death.
In African ART programs with limited access to second-line treatment, mortality, and LTFU are high in the first 3 years of ART. Low retention in care is a major threat to the sustainability of ART delivery in Southern Africa, particularly in rural sites.
在撒哈拉以南非洲的农村地区，有关抗逆转录病毒治疗（ART）项目结果的数据很少。我们描述了南部非洲 6 个农村项目中早期的损失和长期结果，这些项目获得病毒载量监测和二线 ART 的机会有限。
纳入了在津巴布韦、莫桑比克和莱索托各有 2 个项目开始接受 ART 的年龄≥16 岁的患者。我们使用逻辑回归和竞争风险模型评估了开始 ART 后无随访和 3 年 ART 期间死亡率和失访（LTFU）的风险因素。报告了调整性别、年龄组、CD4 组和开始 ART 时的世界卫生组织分期后的比值比和亚分布危险比。
在 7725 名患者中，有 449 名（5.8%）在开始 ART 后未返回。在 9575 人年中，至少有 1 次随访的患者中有 698 人（9.6%）死亡，1319 人（18.1%）LTFU。3 年后，死亡和 LTFU 的累积发生率分别为 12.5%（11.5%-13.5%）和 25.4%（24.0%-26.9%），各国之间存在显著差异：在津巴布韦，3 年后有 75.1%（72.8%-77.3%）的患者存活且在接受 ART，而莱索托为 55.4%（52.8%-58.0%），莫桑比克为 51.6%（48.0%-55.2%）。在所有环境中，年轻年龄和男性性别预测 LTFU，而晚期临床分期和低基线 CD4 计数预测死亡。
在获得二线治疗机会有限的非洲 ART 项目中，ART 治疗的前 3 年死亡率和 LTFU 较高。护理保留率低是南部非洲 ART 持续提供的主要威胁，特别是在农村地区。
