患者失访和 HIV 传播的追踪：基于马拉维 2 个大型抗逆转录病毒治疗项目的数学建模研究。
Tracing of patients lost to follow-up and HIV transmission: mathematical modeling study based on 2 large ART programs in Malawi.
机构信息
*Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; †The International Union Against Tuberculosis and Lung Disease, Paris, France; ‡Lighthouse Trust, Lilongwe, Malawi; §Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa; ‖Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland; ¶Department of Infectious Diseases, University of Dakar, Dakar, Senegal; #International Training and Education Center for Health, University of Washington, Seattle, WA.
出版信息
J Acquir Immune Defic Syndr. 2014 Apr 15;65(5):e179-86. doi: 10.1097/QAI.0000000000000075.
OBJECTIVE
Treatment as prevention depends on retaining HIV-infected patients in care. We investigated the effect on HIV transmission of bringing patients lost to follow-up (LTFU) back into care.
DESIGN
Mathematical model.
METHODS
Stochastic mathematical model of cohorts of 1000 HIV-infected patients on antiretroviral therapy, based on the data from 2 clinics in Lilongwe, Malawi. We calculated cohort viral load (sum of individual mean viral loads each year) and used a mathematical relationship between viral load and transmission probability to estimate the number of new HIV infections. We simulated 4 scenarios: "no LTFU" (all patients stay in care), "no tracing" (patients LTFU are not traced), "immediate tracing" (after missed clinic appointment), and "delayed tracing" (after 6 months).
RESULTS
About 440 of 1000 patients were LTFU over 5 years. Cohort viral loads (million copies/mL per 1000 patients) were 3.7 [95% prediction interval (PrI), 2.9-4.9] for no LTFU, 8.6 (95% PrI, 7.3-10.0) for no tracing, 7.7 (95% PrI, 6.2-9.1) for immediate, and 8.0 (95% PrI, 6.7-9.5) for delayed tracing. Comparing no LTFU with no tracing, the number of new infections increased from 33 (95% PrI, 29-38) to 54 (95% PrI, 47-60) per 1000 patients. Immediate tracing prevented 3.6 (95% PrI, -3.3 to 12.8) and delayed tracing 2.5 (95% PrI, -5.8 to 11.1) new infections per 1000. Immediate tracing was more efficient than delayed tracing: to 116 and 142 tracing efforts, respectively, were needed prevent 1 new infection.
CONCLUSIONS
Tracing of patients LTFU enhances the preventive effect of antiretroviral therapy, but the number of transmissions prevented is small.
目的
治疗即预防取决于将感染艾滋病毒的患者留在护理中。我们研究了将失访（LTFU）的患者带回护理中对艾滋病毒传播的影响。
设计
基于马拉维利隆圭 2 个诊所数据的 1000 名接受抗逆转录病毒治疗的艾滋病毒感染者队列的随机数学模型。我们计算了队列病毒载量（每年个体平均病毒载量的总和），并使用病毒载量与传播概率之间的数学关系来估计新的艾滋病毒感染人数。我们模拟了 4 种情况：“无 LTFU”（所有患者均留在护理中）、“无追踪”（未追踪失访患者）、“立即追踪”（错过就诊预约后）和“延迟追踪”（6 个月后）。
结果
在 5 年内，约有 1000 名患者中的 440 名失访。队列病毒载量（每 1000 名患者百万拷贝/mL）分别为无 LTFU 时为 3.7 [95%预测区间（PrI），2.9-4.9]、无追踪时为 8.6（95% PrI，7.3-10.0）、立即追踪时为 7.7（95% PrI，6.2-9.1），延迟追踪时为 8.0（95% PrI，6.7-9.5）。与无 LTFU 相比，无追踪导致新感染人数从 33（95% PrI，29-38）增加到 54（95% PrI，47-60）每 1000 名患者。立即追踪可预防 3.6（95% PrI，-3.3 至 12.8）和延迟追踪 2.5（95% PrI，-5.8 至 11.1）每 1000 名患者的新感染。立即追踪比延迟追踪更有效：分别需要 116 和 142 次追踪努力来预防 1 次新感染。
结论
追踪失访患者可增强抗逆转录病毒治疗的预防效果，但预防的传播数量很小。
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