Rana Aadia I, Liu Tao, Gillani Fizza S, Reece Rebecca, Kojic Erna M, Zlotnick Caron, Wilson Ira B
a Department of Medicine , Alpert Medical School of Brown University, The Miriam Hospital , Providence , RI , USA.
AIDS Care. 2015;27(6):679-87. doi: 10.1080/09540121.2015.1005002. Epub 2015 Jan 29.
The objective of this study was to identify frequency and predictors of gaps in care in a longitudinal cohort of HIV-infected patients in urban New England. We conducted a retrospective cohort study in Providence, RI, of 581 newly diagnosed HIV patients >18 entering into care from 2004 to 2010, and followed their care through the end of 2011. The outcome of interest was gaps in care, defined as an interruption of medical care for >6 months. Time to the first gap was characterized using Kaplan-Meier (KM) curves. Anderson-Gill proportional hazards (AGPH) model was used to identify the risk factors of recurrent gaps in care. During the study period, 368 patients (63%) experienced at least 1 gap in care, 178 (30%) had ≥2 gaps, 84 (14.5%) had ≥3 gaps, and 21 (3.6%) died; 77% of the gaps were followed by a re-linkage with care The KM curves estimate that one-quarter of patients (95% CI = 22-29%) would experience ≥1 gap in care by Year 1; nearly one-half (CI = 45-54%) by Year 2; and 90% (CI = 93-96%) by Year 8. A prior gap was a strong predictor (HR = 2.36; CI = 2.16-2.58) of subsequent gaps; other predictors included age <25 (HR = 1.29; CI = 1.04-1.60), and no prescription of ART in first year of care (HR = 1.23; CI = 1.01-1.50). The results of this study suggest that a significant proportion of newly diagnosed HIV-infected patients will experience multiple gaps in care and yet re-engagement is possible. Interventions should focus on both prevention of gaps as well as re-engaging those lost to follow-up.
本研究的目的是确定新英格兰城市地区受艾滋病毒感染患者纵向队列中医疗服务缺口的发生率及其预测因素。我们在罗德岛州普罗维登斯市开展了一项回顾性队列研究，研究对象为2004年至2010年开始接受治疗的581名年龄大于18岁的新诊断艾滋病毒患者，并对他们的治疗情况进行跟踪，直至2011年底。感兴趣的结果是医疗服务缺口，定义为医疗中断超过6个月。首次出现缺口的时间通过Kaplan-Meier（KM）曲线进行描述。采用Anderson-Gill比例风险（AGPH）模型来确定医疗服务反复出现缺口的风险因素。在研究期间，368名患者（63%）至少经历过1次医疗服务缺口，178名（30%）有≥2次缺口，84名（14.5%）有≥3次缺口，21名（3.6%）死亡；77%的缺口之后又重新接受了治疗。KM曲线估计，四分之一的患者（95%置信区间=22-29%）在第1年时会经历≥1次医疗服务缺口；到第2年时，近一半（置信区间=45-54%）；到第8年时，90%（置信区间=93-96%）。先前出现过缺口是后续出现缺口的有力预测因素（风险比=2.36；置信区间=2.16-2.58）；其他预测因素包括年龄<25岁（风险比=1.29；置信区间=1.04-1.60），以及在治疗的第一年未接受抗逆转录病毒治疗（风险比=1.23；置信区间=1.01-1.50）。本研究结果表明，相当一部分新诊断的艾滋病毒感染患者会经历多次医疗服务缺口，但重新参与治疗是有可能的。干预措施应既注重预防缺口，也注重让失访患者重新参与治疗。
