Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.
PLoS One. 2013 Oct 1;8(10):e76323. doi: 10.1371/journal.pone.0076323. eCollection 2013.
In developing nations, the use of operational parameters (OPs) in the prediction of clinical care represents a missed opportunity to enhance the care process. We modeled the impact of multiple measurements of antiretroviral treatment (ART) adherence on antiretroviral treatment outcomes in Peru.
Retrospective cohort study including ART naïve, non-pregnant, adults initiating therapy at Hospital Nacional Cayetano Heredia, Lima-Peru (2006-2010). Three OPs were defined: 1) Medication possession ratio (MPR): days with antiretrovirals dispensed/days on first-line therapy; 2) Laboratory monitory constancy (LMC): proportion of 6 months intervals with ≥1 viral load or CD4 reported; 3) Clinic visit constancy (CVC): proportion of 6 months intervals with ≥1 clinic visit. Three multi-variable Cox proportional hazard (PH) models (one per OP) were fit for (1) time of first-line ART persistence and (2) time to second-line virologic failure. All models were adjusted for socio-demographic, clinical and laboratory variables.
856 patients were included in first-line persistence analyses, median age was 35.6 years [29.4-42.9] and most were male (624; 73%). In multivariable PH models, MPR (per 10% increase HR=0.66; 95%CI=0.61-0.71) and LMC (per 10% increase 0.83; 0.71-0.96) were associated with prolonged time on first-line therapies. Among 79 individuals included in time to second-line virologic failure analyses, MPR was the only OP independently associated with prolonged time to second-line virologic failure (per 10% increase 0.88; 0.77-0.99).
The capture and utilization of program level parameters such as MPR can provide valuable insight into patient-level treatment outcomes.
在发展中国家，利用操作参数（OPs）来预测临床护理是增强护理过程的一个错失的机会。我们建立了模型，以评估在秘鲁，多次测量抗逆转录病毒治疗（ART）依从性对 ART 治疗结果的影响。
这是一项回顾性队列研究，纳入了在秘鲁利马的卡耶塔诺·赫雷迪亚国家医院（2006-2010 年）首次接受抗逆转录病毒治疗的初治、非妊娠的成年 ART 患者。定义了三个 OPs：1）药物持有率（MPR）：配药天数/一线治疗天数；2）实验室监测一致性（LMC）：报告≥1 次病毒载量或 CD4 的 6 个月间隔比例；3）就诊次数一致性（CVC）：≥1 次就诊的 6 个月间隔比例。对每个 OP 分别拟合了三个多变量 Cox 比例风险（PH）模型（1）一线 ART 持续时间和（2）二线病毒学失败时间。所有模型均调整了社会人口统计学、临床和实验室变量。
在一线治疗持续时间分析中，纳入了 856 名患者，中位年龄为 35.6 岁[29.4-42.9]，大多数为男性（624 名；73%）。在多变量 PH 模型中，MPR（每增加 10%，HR=0.66；95%CI=0.61-0.71）和 LMC（每增加 10%，0.83；0.71-0.96）与一线治疗时间延长相关。在纳入二线病毒学失败时间分析的 79 名患者中，MPR 是唯一与二线病毒学失败时间延长相关的 OP（每增加 10%，0.88；0.77-0.99）。
捕获和利用 MPR 等项目级别参数可以为患者治疗结果提供有价值的见解。
