International Center for AIDS Care and Treatment Programs-Columbia University, Mailman School of Public Health, New York, New York, United States of America ; Identifying Optimal Models of HIV Care in Africa Study, International Center for AIDS Care and Treatment Programs-Columbia University, New York, New York, United States of America.
International Center for AIDS Care and Treatment Programs-Columbia University, Mailman School of Public Health, New York, New York, United States of America ; Identifying Optimal Models of HIV Care in Africa Study, International Center for AIDS Care and Treatment Programs-Columbia University, New York, New York, United States of America ; Department of Epidemiology, Columbia University, New York, New York, United States of America.
PLoS One. 2014 Jan 15;9(1):e85774. doi: 10.1371/journal.pone.0085774. eCollection 2014.
BACKGROUND: Antiretroviral therapy (ART) improves morbidity and mortality in patients with HIV, however high rates of loss to follow-up (LTF) and mortality have been documented in HIV care and treatment programs. METHODS: We analyzed routinely-collected data on HIV-infected patients ≥ 15 years enrolled at 41 healthcare facilities in Rwanda from 2005 to 2010. LTF was defined as not attending clinic in the last 12 months for pre-ART patients and 6 months for ART patients. For the pre-ART period, sub-distribution hazards models were constructed to estimate LTF and death to account for competing risks. Kaplan-Meier (KM) and Cox proportional hazards models were used for patients on ART. RESULTS: 31,033 ART-naïve adults were included, 64% were female and 75% were WHO stage I or II at enrollment. 17,569 (56%) patients initiated ART. Pre-ART competing risk estimates of LTF at 2 years was 11.2% (95%CI, 10.9-11.6%) and 2.9% for death (95%CI 2.7-3.1%). Among pre-ART patients, male gender was associated with higher LTF (adjusted sub-hazard ratio (aSHR) 1.3, 95%CI 1.1-1.5) and death (aSHR 1.7, 95%CI 1.4-2.1). Low CD4 count (CD4<100 vs. ≥ 350 aSHR 0.2, 95%CI 0.1-0.3) and higher WHO stage (WHO stage IV vs. stage I aSHR 0.4, 95%CI 0.2-0.6) were protective against pre-ART LTF. KM estimates for LTF and death in ART patients at 2 years were 4.4% (95%CI 4.4-4.5%) and 6.3% (95%CI 6.2-6.4%). In patients on ART, male gender was associated with LTF (adjusted hazard ratio (AHR) 1.4, 95%CI 1.2-1.7) and death (AHR1.3, 95%CI 1.2-1.5). Mortality was higher for ART patients ≥ 40 years and in those with lower CD4 count at ART initiation. CONCLUSIONS: Low rates of LTF and death were founds among pre-ART and ART patients in Rwanda but greater efforts are needed to retain patients in care prior to ART initiation, particularly among those who are healthy at enrollment.
背景：抗逆转录病毒疗法（ART）可改善 HIV 感染者的发病率和死亡率，但在 HIV 护理和治疗项目中，已记录到较高的失访（LTF）和死亡率。
方法：我们分析了 2005 年至 2010 年在卢旺达 41 家医疗机构登记的≥15 岁的 HIV 感染患者的常规收集数据。LTF 定义为在过去 12 个月内未在诊所就诊的预 ART 患者和在过去 6 个月内未在诊所就诊的 ART 患者。对于预 ART 期，构建亚分布风险模型以估计 LTF 和死亡，以考虑竞争风险。KM 和 Cox 比例风险模型用于接受 ART 的患者。
结果：共纳入 31033 例初治成人，64%为女性，75%在入组时为 WHO 分期 I 或 II 期。17569 例（56%）患者开始接受 ART。预 ART 的 2 年 LTF 竞争风险估计为 11.2%（95%CI，10.9-11.6%），死亡风险为 2.9%（95%CI 2.7-3.1%）。在预 ART 患者中，男性与更高的 LTF 相关（调整后的亚危险比[aSHR]1.3，95%CI 1.1-1.5）和死亡（aSHR 1.7，95%CI 1.4-2.1）。较低的 CD4 计数（CD4<100 与≥350 aSHR 0.2，95%CI 0.1-0.3）和较高的 WHO 分期（IV 期与 I 期 aSHR 0.4，95%CI 0.2-0.6）与预 ART LTF 呈负相关。ART 患者的 LTF 和死亡的 2 年 KM 估计值分别为 4.4%（95%CI 4.4-4.5%）和 6.3%（95%CI 6.2-6.4%）。在接受 ART 的患者中，男性与 LTF（调整后的危险比[aHR]1.4，95%CI 1.2-1.7）和死亡（aHR 1.3，95%CI 1.2-1.5）相关。年龄≥40 岁和 ART 开始时 CD4 计数较低的 ART 患者死亡率较高。
结论：卢旺达的预 ART 和 ART 患者的 LTF 和死亡率均较低，但需要做出更大努力，以在开始 ART 之前留住患者，特别是在那些在入组时健康的患者。
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