Institute of Tropical Medicine, Antwerp, Belgium.
PLoS One. 2012;7(7):e40971. doi: 10.1371/journal.pone.0040971. Epub 2012 Jul 17.
Retention of patients in ART care is a major challenge in sub-Saharan programs. Retention is also one of the key indicators to evaluate the success of ART programs.
A retrospective review of 1500 randomly selected medical charts of adult ART patients from a local non-governmental (NGO) supported ART program in the Democratic Republic of Congo (DRC). Retention was defined as any visit to the clinic in the 4 months prior to the abstraction date. Retention over time and across different sites was described. The relationship between patient characteristics and retention rates at 1 year was also examined. 1450 patients were included in the analysis. The overall retention rates were 81.4% (95% CI: 79.3-83.4), 75.2% (95% CI: 72.8-77.3), 65.0% (95% CI: 62.3-67.6) and 57.2% (95% CI: 54.0-60.3) at 6 months, 1 year, 2 years and 3 years respectively. The retention rates between sites varied between 62.1% and 90.6% at 6 months and between 55.5% and 86.2% at 1 year. During multivariable analysis weight below 50 kg (aHR: 1.33, 95%CI: 1.05-1.69), higher WHO stage at initiation (aHR: 1.22, 95%CI 0.85-1.76 for stage 3 and aHR: 2.98, 95%CI: 1.93-4.59 for stage 4), and male sex (aHR: 1.32, 95%CI: 1.05-1.65) remained as significant risk factors for attrition during the first year after ART initiation. Other independent risk factors were year of initiation (aHR: 1.73, 95%CI: 1.26-2.38 for the year 2007 and aHR: 3.06, 95%CI: 2.26-4.14 for the period 2008-2009), and site.
Retention is a major problem in DRC, while coverage of patients on ART is still very low. With the flattening of funding for HIV care and treatment in sub-Saharan Africa, and with decreasing funding worldwide, maximizing retention during the much needed scaling-up will even be more important.
在撒哈拉以南的项目中，患者在抗逆转录病毒治疗（ART）中的保留率是一个主要挑战。保留率也是评估 ART 项目成功的关键指标之一。
对刚果民主共和国（DRC）一个当地非政府组织（NGO）支持的 ART 项目中 1500 名成年 ART 患者的随机抽取的医疗记录进行回顾性分析。保留被定义为在提取日期前的 4 个月内任何一次到诊所就诊。描述了随时间和不同地点的保留率。还检查了患者特征与 1 年时保留率之间的关系。1450 名患者纳入分析。总体保留率分别为 6 个月时 81.4%（95%CI：79.3-83.4）、1 年时 75.2%（95%CI：72.8-77.3）、2 年时 65.0%（95%CI：62.3-67.6）和 3 年时 57.2%（95%CI：54.0-60.3）。6 个月时各地点之间的保留率在 62.1%至 90.6%之间，1 年时在 55.5%至 86.2%之间。在多变量分析中，体重低于 50 公斤（aHR：1.33，95%CI：1.05-1.69）、起始时较高的世界卫生组织（WHO）分期（aHR：3 期 1.22，95%CI 0.85-1.76；aHR：4 期 2.98，95%CI：1.93-4.59）和男性（aHR：1.32，95%CI：1.05-1.65）在 ART 启动后第一年仍是流失的显著风险因素。其他独立的风险因素包括起始年份（aHR：2007 年 1.73，95%CI：1.26-2.38；aHR：2008-2009 年期间 3.06，95%CI：2.26-4.14）和地点。
在 DRC，保留率是一个主要问题，而接受 ART 治疗的患者覆盖率仍然很低。随着撒哈拉以南非洲地区艾滋病毒护理和治疗资金的趋平，以及全球资金的减少，在急需扩大规模的过程中最大限度地提高保留率将变得更加重要。
