社会经济支持可减少乌干达综合性社区艾滋病病毒治疗方案中的非保留率。
Socioeconomic support reduces nonretention in a comprehensive, community-based antiretroviral therapy program in Uganda.
机构信息
Medical Department, Reach Out Mbuya HIV/AIDS Initiative, Kampala, Uganda.
出版信息
J Acquir Immune Defic Syndr. 2012 Apr 1;59(4):e52-9. doi: 10.1097/QAI.0b013e318246e2aa.
OBJECTIVES
We evaluated the benefit of socioeconomic support (S-E support), comprising various financial and nonfinancial services that are available based on assessment of need, in reducing mortality and lost to follow-up (LTFU) at Reach Out Mbuya, a community-based, antiretroviral therapy program in Uganda.
DESIGN
Retrospective observational cohort data from adult patients enrolled between May 31, 2001, and May 31, 2010, were examined.
METHODS
Patients were categorized into none, 1, and 2 or more S-E support based on the number of different S-E support services they received. Using Cox proportional hazards regression, we modeled the association between S-E support and mortality or LTFU. Kaplan-Meier curves were fitted to examine retention functions stratified by S-E support.
RESULTS
In total, 6654 patients were evaluated. After 10 years, 2700 (41%) were retained. Of the 3954 not retained, 2933 (74%) were LTFU and 1021 (26%) had died. After 1, 2, 5, and 10 years, the risks of LTFU or mortality in patients who received no S-E support were significantly higher than those who received some S-E support. In adjusted hazards ratios, patients who received no S-E support were 1.5-fold (1.39-1.64) and 6.7-fold (5.56-7.69) more likely to get LTFU compared with those who received 1 or ≥ 2 S-E support, respectively. Likewise, patients who received no S-E support were 1.5-fold (confidence interval: 1.16 to 1.89) and 4.3-fold (confidence interval: 2.94 to 6.25) more likely to die compared with those who received 1 or 2+ S-E support, respectively.
CONCLUSIONS
Provision of S-E support reduced LTFU and mortality, suggesting the value of incorporating such strategies for promoting continuity of care.
目的
我们评估了社会经济支持（S-E 支持）的益处，该支持包括根据需要评估提供的各种财务和非财务服务，以降低乌干达 Reach Out Mbuya 社区为基础的抗逆转录病毒治疗项目中的死亡率和失访率（LTFU）。
设计
对 2001 年 5 月 31 日至 2010 年 5 月 31 日期间登记的成年患者的回顾性观察队列数据进行了检查。
方法
根据患者接受的不同 S-E 支持服务的数量，将患者分为无、1 和 2 或更多 S-E 支持。使用 Cox 比例风险回归模型，我们对 S-E 支持与死亡率或 LTFU 之间的关联进行建模。Kaplan-Meier 曲线用于检查按 S-E 支持分层的保留功能。
结果
共有 6654 名患者接受了评估。10 年后，有 2700 名（41%）患者得到保留。在未保留的 3954 名患者中，有 2933 名（74%）为 LTFU，1021 名（26%）死亡。在 1、2、5 和 10 年后，未接受 S-E 支持的患者发生 LTFU 或死亡的风险明显高于接受 S-E 支持的患者。在调整后的风险比中，未接受 S-E 支持的患者发生 LTFU 的可能性分别是接受 1 种或≥2 种 S-E 支持的患者的 1.5 倍（1.39-1.64）和 6.7 倍（5.56-7.69）。同样，未接受 S-E 支持的患者死亡的可能性分别是接受 1 种或 2 种以上 S-E 支持的患者的 1.5 倍（置信区间：1.16 至 1.89）和 4.3 倍（置信区间：2.94 至 6.25）。
结论
提供 S-E 支持可降低 LTFU 和死亡率，表明纳入此类策略促进护理连续性具有价值。
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