*Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, MD; †Division of HIV/AIDS and Center for AIDS Prevention Studies, University of California, San Francisco, CA; ‡The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH; §Reach Out-Mbuya, Kampala, Uganda; ‖Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD; ¶Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MD; and #Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
J Acquir Immune Defic Syndr. 2014 May 1;66(1):41-7. doi: 10.1097/QAI.0000000000000094.
To delineate the association between baseline socioeconomic status (SES) indicators and mortality and lost to follow-up (LTFU) in a cohort of HIV-infected individuals enrolled in antiretroviral therapy (ART) in urban Uganda.
Retrospective cohort study nested in an antiretroviral clinic-based cohort.
SES indicators including education, employment status, and a standardized wealth index, and other demographic and clinical variables were assessed at baseline among ART-treated patients in a clinic-based cohort in Kampala, Uganda. Confirmed mortality (primary outcome) and LTFU (secondary outcome) were actively ascertained over a 4-year follow-up period from 2005 to 2009.
Among 1763 adults [70.5% female; mean age, 36.2 years (SD = 8.4)] enrolled in ART, 14.4% (n = 253) were confirmed dead and 19.7% (n = 346) were LTFU at 4-year follow-up. No formal education [adjusted odds ratio (AOR) 1.76; 95% confidence interval (CI): 1.19 to 2.59], having fewer than 6 dependents (AOR 1.39; 95% CI: 1.04 to 1.86), unemployment (AOR 1.98; 95% CI: 1.48 to 2.66), and housing tenure index score (a component of the wealth index) (AOR 1.11; 95% CI: 1.00 to 1.23) were significantly associated with confirmed mortality at 4 years. SES indicators were not associated with LTFU at 4 years.
Baseline SES indicators, including education, number of dependents, employment status, and components of a standard wealth index may indicate long-term vulnerability to mortality in patients with HIV/AIDS, despite uniform access to ART. Future studies delineating the pathways through which poverty and limited assets affect clinical outcomes may lead to more effective HIV interventions in low-resource settings.
描绘乌干达城市中接受抗逆转录病毒疗法（ART）的艾滋病毒感染者队列中，基线社会经济地位（SES）指标与死亡率和失访（LTFU）之间的关联。
嵌套在基于抗病毒诊所队列中的回顾性队列研究。
在乌干达坎帕拉的一个基于诊所队列的接受 ART 治疗的患者中，评估 SES 指标，包括教育、就业状况和标准化财富指数，以及其他人口统计学和临床变量。在 2005 年至 2009 年的 4 年随访期间，积极确定确认的死亡率（主要结局）和 LTFU（次要结局）。
在 1763 名成年人中（70.5%为女性；平均年龄 36.2 岁[SD=8.4]），14.4%（n=253）在 4 年随访时被确认死亡，19.7%（n=346）失访。未接受正规教育[校正优势比（AOR）1.76；95%置信区间（CI）：1.19 至 2.59]、有少于 6 个家属[AOR 1.39；95%CI：1.04 至 1.86]、失业[AOR 1.98；95%CI：1.48 至 2.66]和住房保有指数得分（财富指数的一个组成部分）（AOR 1.11；95%CI：1.00 至 1.23）与 4 年时的死亡率显著相关。SES 指标与 4 年时的 LTFU 无关。
尽管获得了统一的 ART，但基线 SES 指标，包括教育、家属人数、就业状况和标准财富指数的组成部分，可能表明 HIV/AIDS 患者在长期内易受死亡率影响。未来的研究描绘贫困和有限资产影响临床结果的途径，可能会导致在资源匮乏的环境中更有效的 HIV 干预措施。
