在撒哈拉以南非洲的抗逆转录病毒治疗患者中，坚持支持和外展服务与总脱落、失访和死亡的关系。
Association of adherence support and outreach services with total attrition, loss to follow-up, and death among ART patients in sub-Saharan Africa.
机构信息
International Center for AIDS Care and Treatment Programs (ICAP), Mailman School of Public Health, Columbia University, New York, New York, United States of America.
出版信息
PLoS One. 2012;7(6):e38443. doi: 10.1371/journal.pone.0038443. Epub 2012 Jun 7.
BACKGROUND
Loss to follow-up (LTF) after antiretroviral therapy (ART) initiation is common in HIV clinics. We examined the effect of availability of adherence support and active patient outreach services on patient attrition following ART initiation.
METHODS AND FINDINGS
This ecologic study examined clinic attrition rates (total attrition, LTF, and death) among 232,389 patients initiating ART at 349 clinics during 2004-2008 in 10 sub-Saharan African countries, and cohort attrition (proportion retained at 6 and 12 months after ART initiation) among a subset of patients with follow-up information (n=83,389). Log-linear regression compared mean rates of attrition, LTF, and death between clinics with and without adherence support and outreach services. Cumulative attrition, LTF, and death rates were 14.2, 9.2, and 4.9 per 100 person-years on ART, respectively. In multivariate analyses, clinic availability of >2 adherence support services was marginally associated with lower attrition rates (RR(adj)=0.59, 95%CI: 0.35-1.0). Clinics with availability of counseling services (RR(adj)=0.62, 95%CI: 0.42-0.92), educational materials (RR(adj)=0.73, 95%CI: 0.63-0.85), reminder tools (RR(adj)=0.79, 95%CI: 0.64-0.97), and food rations (RR(adj)=0.72, 95%CI: 0.58-0.90) had significantly lower attrition, with similar results observed for LTF. Outreach services were not significantly associated with attrition. In cohort analyses, attrition was significantly lower at clinics offering >2 adherence support services (RR(adj,6m)=0.84, 95%CI: 0.73-0.96), dedicated pharmacy services (RR(adj,6m)=0.78, 95%CI: 0.69-0.90), and active patient outreach (RR(adj,6m)=0.85, 95%CI: 0.73-0.99). Availability of food rations was marginally associated with increased retention at 6 (RR(adj,6m) =0.82, 95%CI: 0.64-1.05) but not 12 months (RR(adj,12m) =0.98, 95%CI: 0.78-1.21).
CONCLUSIONS
Availability of adherence support services, active patient outreach and food rations at HIV care clinics may improve retention following ART initiation.
背景
在开始抗逆转录病毒疗法（ART）后，艾滋病毒诊所中经常出现失访（LTF）的情况。我们研究了在开始 ART 后，提供依从性支持和积极的患者外展服务对患者流失的影响。
方法和发现
这项生态研究检查了在 2004-2008 年期间，10 个撒哈拉以南非洲国家的 349 个诊所中 232389 名开始接受 ART 的患者的诊所流失率（总流失率、LTF 和死亡率），以及具有随访信息的患者亚组（n=83389）的队列流失率（在开始接受 ART 后 6 个月和 12 个月时保留的比例）。对数线性回归比较了具有和不具有依从性支持和外展服务的诊所之间的平均流失率、LTF 和死亡率。ART 期间，每 100 人年的累积流失率、LTF 和死亡率分别为 14.2、9.2 和 4.9。在多变量分析中，诊所提供>2 种依从性支持服务与较低的流失率相关（RR（adj）=0.59，95%CI：0.35-1.0）。提供咨询服务（RR（adj）=0.62，95%CI：0.42-0.92）、教育材料（RR（adj）=0.73，95%CI：0.63-0.85）、提醒工具（RR（adj）=0.79，95%CI：0.64-0.97）和食物配给（RR（adj）=0.72，95%CI：0.58-0.90）的诊所，其流失率明显较低，LTF 也有类似的结果。外展服务与流失率无显著相关性。在队列分析中，提供>2 种依从性支持服务（RR（adj，6m）=0.84，95%CI：0.73-0.96）、专门的药房服务（RR（adj，6m）=0.78，95%CI：0.69-0.90）和积极的患者外展（RR（adj，6m）=0.85，95%CI：0.73-0.99）的诊所的流失率明显较低。食物配给的提供与 6 个月时的保留率增加（RR（adj，6m）=0.82，95%CI：0.64-1.05）相关，但与 12 个月时的保留率增加无关（RR（adj，12m）=0.98，95%CI：0.78-1.21）。
结论
在艾滋病毒护理诊所提供依从性支持服务、积极的患者外展和食物配给可能会改善 ART 启动后的保留率。
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