Johnson D C, Feldacker C, Tweya H, Phiri S, Hosseinipour M C
University of North Carolina.
Int J STD AIDS. 2013 Jan;24(1):42-9. doi: 10.1177/0956462412472312. Epub 2013 May 6.
The World Health Organization (WHO) estimates that only 30% of eligible, HIV-infected individuals start antiretroviral therapy (ART). This study seeks to explore the geographic and individual factors associated with starting ART on time. This retrospective study includes 15,734 HIV-positive adults initiating ART at two HIV clinics in Lilongwe, Malawi. The outcome was starting ART within two weeks of meeting ART eligibility as defined by the Malawi ART guidelines. Euclidean distance from patient neighbourhood to their clinic was calculated using Google Earth. Logistic regression models assessed factors influencing starting ART on time. Of 15,734 adults initiating ART, 8178 were from Lighthouse (LH) and 7556 were from Martin Preuss Center (MPC). Combined, 68.7% started treatment on time. Patients who were eligible for ART based on a CD4 cell count <250 cells/mm(3) versus WHO stage were less likely to begin ART on time at both LH (odds ratio [OR] 0.16; 95% CI 0.13-0.19) and MPC (OR 0.24; 95% CI 0.21-0.28). Likelihood of starting on time decreased with each kilometer further from clinic location among LH patients (OR 0.97; 95% CI 0.94-0.99); distance was not significant at MPC. In conclusion, predictors differed by clinic. Distance to clinic and type of eligibility for ART significantly influence starting ART on time.
世界卫生组织（WHO）估计，在符合条件的HIV感染者中，只有30%开始接受抗逆转录病毒疗法（ART）。本研究旨在探讨与按时开始ART相关的地理和个体因素。这项回顾性研究纳入了在马拉维利隆圭的两家HIV诊所开始接受ART的15734名HIV阳性成年人。结局指标是根据马拉维ART指南，在达到ART治疗标准后的两周内开始接受ART。使用谷歌地球计算患者所在社区到诊所的欧几里得距离。逻辑回归模型评估了影响按时开始ART的因素。在15734名开始接受ART的成年人中，8178名来自灯塔诊所（LH），7556名来自马丁·普吕斯中心诊所（MPC）。总体而言，68.7%的患者按时开始治疗。在LH诊所（比值比[OR]为0.16；95%置信区间为0.13 - 0.19）和MPC诊所（OR为0.24；95%置信区间为0.21 - 0.28），基于CD4细胞计数<250个细胞/mm³与WHO分期标准符合ART治疗条件的患者按时开始ART的可能性较小。在LH诊所的患者中，离诊所每远一公里，按时开始治疗的可能性就降低（OR为0.97；95%置信区间为0.94 - 0.99）；在MPC诊所，距离因素不显著。总之，不同诊所的预测因素有所不同。到诊所的距离和ART治疗资格类型显著影响按时开始ART。
