Christopoulos Katerina A, Scheer Susan, Steward Wayne T, Barnes Revery, Hartogensis Wendy, Charlebois Edwin D, Morin Stephen F, Truong Hong-Ha M, Geng Elvin H
*HIV/AIDS Division, San Francisco General Hospital, University of California, San Francisco, San Francisco, CA; †HIV Epidemiology Section, San Francisco Department of Public Health, San Francisco, CA; ‡Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA; and §Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA.
J Acquir Immune Defic Syndr. 2015 May 1;69 Suppl 1(0 1):S56-62. doi: 10.1097/QAI.0000000000000571.
Clinic-based tracing efforts and public health surveillance data can provide different information about HIV care status for the same patients. The relative yield and how best to use these sources to identify and reengage out-of-care patients is unknown.
At a large public HIV clinic in San Francisco, we selected a 10% random sample of active patients who were at least 210 days "late" for an HIV primary care visit as of April 1, 2013, for clinic-based outreach. Patients were considered out of care if they did not have an HIV primary care visit in the 210 days before April 1, 2013. We then matched the sample with the San Francisco Department of Public Health HIV surveillance registry. Patients with a CD4 or viral load result in the 210-day period were classified as in care. We compared results from both sources and estimated the cumulative incidence of disengagement from care for the full cohort of clinic patients.
Of 940 patients lost to follow-up, 95 were sampled. Clinic tracing found 60 (63%) in care, 23 (24%) not located, 9 (10%) out of care, 2 (2%) incarcerated, and 1 (1%) had died. Of 42 individuals surveillance classified as out of care, tracing found 22 (52%) were in care. Of 52 patients found to be in care by surveillance, 12 (23%) were out of care by clinic tracing or unable to be located. The naive estimate of the cumulative incidence of disengagement from care at 3 years for the active clinic cohort was 41.1% [95% confidence interval (CI): 37.6 to 44.5]. The use of surveillance data reduced this estimate to 12.7% (95% CI: 18.2 to 25.4), and when further corrected using tracing outcomes, the estimate dropped to only 6.4% (95% CI: 3.4 to 9.4).
Clinic-based tracing and surveillance data together provide a better understanding of care status than either method alone. Using surveillance data to inform clinic-based outreach efforts may be an effective strategy, although tracing efforts are most likely to be successful if conducted in real time.
基于诊所的追踪工作和公共卫生监测数据可为同一患者提供有关艾滋病病毒治疗状况的不同信息。这些来源的相对产出以及如何最好地利用它们来识别和重新联系失访患者尚不清楚。
在旧金山一家大型公共艾滋病诊所，我们从活跃患者中随机抽取了10%的样本，这些患者截至2013年4月1日距离艾滋病病毒初级保健就诊至少“逾期”210天，以进行基于诊所的外展工作。如果患者在2013年4月1日前的210天内没有进行艾滋病病毒初级保健就诊，则被视为失访。然后我们将样本与旧金山市公共卫生部艾滋病病毒监测登记册进行匹配。在这210天内有CD4或病毒载量检测结果的患者被归类为在接受治疗。我们比较了两种来源的结果，并估计了整个诊所患者队列中失访的累积发生率。
在940名失访患者中，抽取了95名。诊所追踪发现60名（63%）在接受治疗，23名（24%）未找到，9名（10%）失访，2名（2%）被监禁，1名（1%）已死亡。在监测归类为失访的42人中，追踪发现22人（52%）在接受治疗。在监测发现接受治疗的52名患者中，12名（23%）通过诊所追踪被归类为失访或无法找到。活跃诊所队列3年失访累积发生率的初步估计为41.1%[95%置信区间（CI）：37.6至44.5]。使用监测数据将这一估计降至12.7%（95%CI：18.2至25.4），当使用追踪结果进一步校正时，估计仅降至6.4%（95%CI：3.4至9.4）。
基于诊所的追踪和监测数据共同提供的治疗状况信息比单独使用任何一种方法都更好。利用监测数据为基于诊所的外展工作提供信息可能是一种有效策略，尽管追踪工作如果实时进行最有可能成功。
