Fox Matthew P, Shearer Kate, Maskew Mhairi, Meyer-Rath Gesine, Clouse Kate, Sanne Ian
Center for Global Health & Development, Boston University, Boston, Massachusetts, United States of America; Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America.
Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
PLoS One. 2014 Oct 20;9(10):e110252. doi: 10.1371/journal.pone.0110252. eCollection 2014.
While momentum for increasing treatment thresholds is growing, if patients cannot be retained in HIV care from the time of testing positive through long-term adherence to antiretroviral therapy (ART), such strategies may fall short of expected gains. While estimates of retention on ART exist, few cohorts have data on retention from testing positive through long-term ART care.
We explored attrition (loss or death) at the Themba Lethu HIV clinic, Johannesburg, South Africa in 3 distinct cohorts enrolled at HIV testing, pre-ART initiation, and ART initiation.
Between March 2010 and August 2012 we enrolled 380 patients testing HIV+, 206 initiating pre-ART care, and 185 initiating ART. Of the 380 patients enrolled at testing HIV-positive, 38.7% (95%CI: 33.9-43.7%) returned for eligibility staging within ≤3 months of testing. Of the 206 enrolled at pre-ART care, 84.5% (95%CI: 79.0-88.9%) were ART eligible at their first CD4 count. Of those, 87.9% (95%CI: 82.4-92.2%) initiated ART within 6 months. Among patients not ART eligible at their first CD4 count, 50.0% (95%CI: 33.1-66.9%) repeated their CD4 count within one year of the first ineligible CD4. Among the 185 patients in the ART cohort, 22 transferred out and were excluded from further analysis. Of the remaining 163, 81.0% (95%CI: 74.4-86.5%) were retained in care through two years on treatment.
Our findings from a well-resourced clinic demonstrate continual loss from all stages of HIV care and strategies to reduce attrition from all stages of care are urgently needed.
尽管提高治疗阈值的势头日益增强，但如果患者从检测呈阳性时起无法通过长期坚持抗逆转录病毒疗法（ART）而留在HIV治疗中，此类策略可能无法实现预期收益。虽然存在关于ART留存率的估计，但很少有队列拥有从检测呈阳性到长期ART治疗的留存数据。
我们在南非约翰内斯堡的Themba Lethu HIV诊所，对在HIV检测、ART启动前以及ART启动时入组的3个不同队列中的人员流失（失访或死亡）情况进行了探究。
在2010年3月至2012年8月期间，我们纳入了380名HIV检测呈阳性的患者、206名开始接受ART启动前护理的患者以及185名开始接受ART治疗的患者。在380名HIV检测呈阳性时入组的患者中：38.7%（95%置信区间：33.9 - 43.7%）在检测后≤3个月内返回进行资格评估。在206名接受ART启动前护理的患者中，首次CD4细胞计数时84.5%（95%置信区间：79.0 - 88.9%）符合ART治疗标准。其中，87.9%（95%置信区间：82.4 - 92.2%）在6个月内开始接受ART治疗。在首次CD4细胞计数时不符合ART治疗标准的患者中，50.0%（95%置信区间：？？？）在首次不符合标准的CD4细胞计数后一年内再次进行了CD4细胞计数。在ART队列的185名患者中，22名转出并被排除在进一步分析之外。在其余163名患者中，81.0%（95%置信区间：74.4 - 86.5%）在接受治疗两年期间持续接受护理。
我们在资源充足的诊所的研究结果表明，HIV治疗各阶段均持续存在失访情况，迫切需要采取策略减少各阶段的人员流失。 （注：原文中“Among patients not ART eligible at their first CD4 count, 50.0% (95%CI: 33.1 - 66.9%) repeated their CD4 count within one year of the first ineligible CD4.”中95%置信区间部分原文有误，我按照正确逻辑进行了翻译并标注疑问）
