de Almeida Meire Cavalieri, de Jesus Pedroso Nayara, do Socorro Lina van Keulen Maria, Jácome Guillermo Patrício Ortega, Fernandes Guilherme Côrtes, Yokoo Edna Massae, Tuboi Suely Hiromi
Instituto de Saúde da Comunidade, Universidade Federal Fluminense, Niterói, RJ, Brazil,
AIDS Behav. 2014 Dec;18(12):2387-96. doi: 10.1007/s10461-014-0812-1.
One of the main aspects related to non-adherence to combined antiretroviral therapy (cART) for patients infected with the Human Immunodeficiency Virus (HIV) refers to the abandonment of outpatient care. This study was aimed to estimate the loss to follow-up in outpatient HIV care at a Regional Referral Clinic (SAE) for HIV/AIDS in the city of Juiz de Fora, Brazil, and to identify associated factors and predictors. This is a prospective cohort of patients older than 18 years, under cART and regular outpatient care. The study included patients who attended medical visits during July-August 2011. Those who did not return to the clinic for new medical appointments within 90 days after the sixth month of follow up were considered lost to follow-up in outpatient care. Variables with P value ≤0.25 in the univariate analysis were included in a logistic regression model, adopting a significance level of 0.05. Among the 250 patients included in the study, 44 (17.6 %) were lost to follow up in outpatient care. Among these, 38 (86.4 %) were located in the cART delivery database system (SICLOM). Younger patients (≤43 versus >43 years) (OR 2.30 CI 1.06-5.00, P = 0.04), and patients attended by physician "E", when compared with physicians "A", "B", "C" or "D" (OR 5.90 CI 2.64-13.18, P = 0.00) were more likely to be lost to follow-up. Patients admitted in the service for 7 years or more were also more likely to be to lost to follow-up (OR 2.27 CI 1.2-4.4, P = 0.01), although this association did not remain statistically significant in the multivariate analysis. Although the purpose of the study, to identify individual factors associated to loss to follow-up, positives associations with a specific physician and with patients admitted in the service for 7 years or more suggest organizational factors. Although the majority of patients lost to follow-up in outpatient care were detected by SICLOM, a detectable viral load in most of these patients suggest a quality of outpatient HIV care proved ineffective, despite the availability of cART. We conclude on the need for further studies to investigate structural factors associated to loss to follow-up when enhanced retention strategies should be implemented in order to maintain an effective outpatient HIV care.
对于感染人类免疫缺陷病毒（HIV）的患者而言，不坚持联合抗逆转录病毒疗法（cART）的一个主要方面是放弃门诊治疗。本研究旨在评估巴西茹伊斯迪福拉市一家HIV/AIDS区域转诊诊所（SAE）门诊HIV治疗中的失访情况，并确定相关因素和预测因素。这是一项对年龄超过18岁、接受cART治疗且定期接受门诊治疗的患者进行的前瞻性队列研究。该研究纳入了在2011年7月至8月期间就诊的患者。那些在随访第六个月后90天内未返回诊所进行新的预约就诊的患者被视为门诊治疗失访。单因素分析中P值≤0.25的变量被纳入逻辑回归模型，显著性水平设定为0.05。在该研究纳入的250名患者中，有44名（17.6%）在门诊治疗中失访。其中，38名（86.4%）在cART发放数据库系统（SICLOM）中被找到。年轻患者（≤43岁与>43岁相比）（比值比[OR]为2.30，置信区间[CI]为1.06 - 5.00，P = 0.04），以及由医生“E”诊治而非医生“A”、“B”、“C”或“D”诊治的患者（OR为5.90，CI为2.64 - 13.18，P = 0.00）更有可能失访。在该机构住院7年或更长时间的患者也更有可能失访（OR为2.27，CI为1.2 - 4.4，P = 0.01），尽管这种关联在多因素分析中不再具有统计学显著性。尽管该研究的目的是确定与失访相关的个体因素，但与特定医生以及在该机构住院7年或更长时间的患者存在正相关，这表明存在组织因素。尽管大多数门诊治疗失访的患者通过SICLOM被发现，但这些患者中大多数可检测到病毒载量，这表明尽管有cART可用，但门诊HIV治疗质量被证明是无效的。我们得出结论，需要进一步研究以调查与失访相关的结构因素，届时应实施强化留治策略以维持有效的门诊HIV治疗。
