School of Health Physical Education and Recreation, Bloomington, USA.
Clin Infect Dis. 2012 Jan 15;54(2):275-81. doi: 10.1093/cid/cir789. Epub 2011 Dec 8.
BACKGROUND: This article describes the effect point of entry into the human immunodeficiency virus (HIV) care program had on the clinical status of adults presenting for the first time to USAID-AMPATH (US Agency for International Development-Academic Model Providing Access to Healthcare) Partnership clinics for HIV care. METHODS: All patients aged ≥ 14 years enrolled between August 2008 and April 2010 were included. Points of entry to USAID-AMPATH clinics were home-based counseling and testing (HBCT), provider-initiated testing and counseling (PITC), HIV testing in the tuberculosis clinic, and voluntary counseling and testing (VCT). Tests for trend were calculated, and multivariable logistic regression was used to compare the effect of HBCT versus other points of entry on primary outcomes controlling for age and sex. RESULTS: There were 19,552 eligible individuals. Of these, 946 tested in HBCT, 10,261 in VCT, 8073 in PITC, and 272 in the tuberculosis clinic. The median (interquartile range) enrollment CD4 cell counts among those who tested HIV positive was 323 (194-491), 217 (87-404), 190 (70-371), and 136 cells/mm(3) (59-266) for HBCT, VCT, PITC, and the tuberculosis clinic, respectively (P < .001). Compared with those patients whose HIV infection was diagnosed in the tuberculosis clinic, those who tested positive in HBCT were, controlling for age and sex, less likely to have to have World Health Organization stage III or IV HIV infection at enrollment (adjusted odds ratio [AOR], 0.04; 95% confidence interval [CI], .03-.06), less likely to enroll with a CD4 cell count of <200 cells/mm(3) (AOR, 0.20; 95% CI, .14-.28), and less likely to enroll into care with a chief complaint (AOR, 0.08; 95% CI, .05-.12). CONCLUSIONS: HBCT is effective at getting HIV-infected persons enrolled in HIV care before they become ill.
背景:本文描述了艾滋病毒(HIV)感染者进入人类免疫缺陷病毒(HIV)护理项目时对首次到美援署-AMPATH(美国国际开发署-学术模式提供医疗保健机会)合作诊所就诊的成年人临床状况的影响。
方法:所有年龄≥14 岁并于 2008 年 8 月至 2010 年 4 月间入组的患者均被纳入。美援署-AMPATH 诊所的入组途径有家庭咨询和检测(HBCT)、医生发起的检测和咨询(PITC)、结核诊所的 HIV 检测以及自愿咨询和检测(VCT)。采用趋势检验计算,并用多变量逻辑回归比较 HBCT 与其他入组途径对主要结局的影响,控制年龄和性别。
结果:共有 19552 名合格个体。其中 946 人在 HBCT 中检测,10261 人在 VCT 中检测,8073 人在 PITC 中检测,272 人在结核诊所中检测。在 HIV 阳性检测者中,HBCT、VCT、PITC 和结核诊所的中位(四分位距)CD4 细胞计数分别为 323(194-491)、217(87-404)、190(70-371)和 136 个细胞/mm3(59-266)(P<0.001)。与在结核诊所诊断 HIV 感染的患者相比,HBCT 检测阳性的患者,在控制年龄和性别后,不太可能在入组时患有世卫组织 III 或 IV 期 HIV 感染(调整后的优势比 [AOR],0.04;95%置信区间 [CI],0.03-0.06),不太可能在 CD4 细胞计数<200 个细胞/mm3 时入组(AOR,0.20;95% CI,0.14-0.28),不太可能以主诉入组(AOR,0.08;95% CI,0.05-0.12)。
结论:HBCT 能够有效地让 HIV 感染者在患病前就开始接受 HIV 护理。
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