Clinical HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
PLoS One. 2013;8(1):e49140. doi: 10.1371/journal.pone.0049140. Epub 2013 Jan 16.
To assess the outcomes of linkage to TB and HIV care and identify risk factors for poor referral outcomes.
Cohort study of TB patients diagnosed at an urban hospital.
Linkage to care was determined by review of clinic files, national death register, and telephone contact, and classified as linked to care, delayed linkage to care (>7 days for TB treatment, >30 days for HIV care), or failed linkage to care. We performed log-binomial regression to identify patient and referral characteristics associated with poor referral outcomes.
Among 593 TB patients, 23% failed linkage to TB treatment and 30.3% of the 77.0% who linked to care arrived late. Among 486 (86.9%) HIV-infected TB patients, 38.3% failed linkage to HIV care, and 32% of the 61.7% who linked to care presented late. One in six HIV-infected patients failed linkage to both TB and HIV care. Only 20.2% of HIV-infected patients were referred to a single clinic for integrated care. A referral letter was present in 90.3%, but only 23.7% included HIV status and 18.8% CD4 cell count. Lack of education (RR 1.85) and low CD4 count (CD4≤50 vs. >250cells/mm(3); RR 1.66) were associated with failed linkage to TB care. Risk factors for failed linkage to HIV care were antiretroviral-naïve status (RR 1.29), and absence of referral letter with HIV or CD4 cell count (RR1.23).
Linkage to TB/HIV care should be strengthened by communication of HIV and CD4 results, ART initiation during hospitalization and TB/HIV integration at primary care.
评估结核和 HIV 护理衔接的结局，并确定衔接不良的风险因素。
对一家市级医院诊断的结核患者进行队列研究。
通过查看临床病历、国家死亡登记和电话联系来确定患者是否被衔接至医疗照护，并将其分类为衔接至照护、延迟衔接（结核治疗超过 7 天，HIV 照护超过 30 天）或衔接失败。我们进行了对数二项式回归分析，以确定与转介结果不良相关的患者和转介特征。
在 593 例结核患者中，有 23%的患者未能衔接至结核治疗，而在 77.0%衔接至照护的患者中，有 30.3%的患者延迟就诊。在 486 例（86.9%）HIV 感染的结核患者中，有 38.3%的患者未能衔接至 HIV 照护，而在 61.7%衔接至照护的患者中，有 32%的患者延迟就诊。六分之一的 HIV 感染患者未能同时衔接结核和 HIV 照护。只有 20.2%的 HIV 感染患者被转诊至一个综合诊所接受治疗。转诊信的存在率为 90.3%，但仅有 23.7%的转诊信包含 HIV 状态，而 18.8%的转诊信包含 CD4 细胞计数。缺乏教育（RR 1.85）和低 CD4 计数（CD4≤50 与>250 个细胞/mm³；RR 1.66）与结核照护衔接失败相关。HIV 照护衔接失败的风险因素包括未接受抗逆转录病毒治疗（RR 1.29）以及转诊信未包含 HIV 或 CD4 细胞计数（RR1.23）。
应通过沟通 HIV 和 CD4 结果、在住院期间启动抗逆转录病毒治疗以及在初级保健机构整合结核和 HIV 照护来加强结核和 HIV 护理的衔接。
