Epidemiology Unit, National AIDS Control Programme, Dar-es-Salaam, Tanzania.
Trop Med Int Health. 2012 Apr;17(4):497-506. doi: 10.1111/j.1365-3156.2011.02952.x. Epub 2012 Feb 1.
OBJECTIVE To analyse survival and retention rates of the Tanzanian care and treatment programme.
Routine patient-level data were available from 101 of 909 clinics. Kaplan-Meier probabilities of mortality and attrition after ART initiation were calculated. Mortality risks were corrected for biases from loss to follow-up using Egger's nomogram. Smoothed hazard rates showed mortality and attrition peaks. Cox regression identified factors associated with death and attrition. Median CD4 counts were calculated at 6 month intervals.
In 88,875 adults, 18% were lost to follow up 12 months after treatment initiation, and 36% after 36 months. Cumulative mortality reached 10% by 12 months (15% after correcting for loss to follow-up) and 14% by 36 months. Mortality and attrition rates both peaked within the first six months, and were higher among males, those under 45 kg and those with CD4 counts below 50 cells/μl at ART initiation. In the first year on ART, median CD4 count increased by 126 cells/μl, with similar changes in both sexes.
Earlier diagnoses through expanded HIV testing may reduce high mortality and attrition rates if combined with better patient tracing systems. Further research is needed to explore reasons for attrition.
分析坦桑尼亚护理和治疗方案的生存率和保留率。
从 909 个诊所中的 101 个诊所获得了常规的患者水平数据。计算了开始接受抗逆转录病毒治疗后的死亡率和流失率的 Kaplan-Meier 概率。使用 Egger 的列线图纠正了因失访导致的死亡率偏倚。平滑的危险率显示了死亡率和流失率的高峰。Cox 回归确定了与死亡和流失相关的因素。每隔 6 个月计算一次 CD4 计数的中位数。
在 88875 名成年人中，12 个月后有 18%失去随访，36 个月后有 36%失去随访。12 个月时累积死亡率达到 10%（经校正失访后为 15%），36 个月时达到 14%。死亡率和流失率均在头六个月达到高峰，且在男性、体重不足 45 公斤和开始抗逆转录病毒治疗时 CD4 计数低于 50 个细胞/μl 的人群中更高。在开始接受抗逆转录病毒治疗的第一年，CD4 计数中位数增加了 126 个细胞/μl，男女之间的变化相似。
通过扩大艾滋病毒检测进行更早的诊断，如果结合更好的患者跟踪系统，可能会降低高死亡率和流失率。需要进一步研究以探讨流失的原因。
