Levira Francis, Agnarson Abela Mpobela, Masanja Honorati, Zaba Basia, Ekström Anna Mia, Thorson Anna
Data Analysis Cluster, Ifakara Health Institute, Plot 463, Kiko Avenue, Mikocheni, P O Box 78378, Dar es salaam, Tanzania.
Department of Public Health Sciences/Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
BMC Public Health. 2015 Feb 27;15:195. doi: 10.1186/s12889-015-1460-8.
The Tanzanian Government started scaling up its antiretroviral treatment (ART) program from referral, regional and district hospitals to primary health care facilities in October 2004. In 2010, most ART clinics were decentralized to primary health facilities. ART coverage, i.e. people living with HIV (PLHIV) on combination treatment as a proportion of those in need of treatment, provides the basis for evaluating the efficiency of ART programs at national and district level. We aimed to evaluate adult ART and pre-ART care coverage by age and sex at CD4 < 200, < 350 and all PLHIV in the Rufiji district of Tanzania from 2006 to 2010.
The numbers of people on ART and pre-ART care were obtained from routinely aggregated, patient-level, cohort data from care and treatment centers in the district. We used ALPHA model to predict the number in need of pre-ART care and ART by age and sex at CD4 < 200 and < 350.
Adult ART coverage among PLHIV increased from 2.9% in 2006 to 17.6% in 2010. In 2010, coverage was 20% for women and 14.8% for men. ART coverage was 30.2% and 38.7% in 2010 with reference to CD4 criteria of 350 and 200 respectively. In 2010, ART coverage was 0 and 3.4% among young people aged 15-19 and 20-24 respectively. ART coverage among females aged 35-39 and 40-44 was 30.6 and 35% respectively in 2010. Adult pre-ART care coverage for PLHIV of CD4 < 350 increased from 5% in 2006 to 37.7% in 2010. The age-sex coverage patterns for pre-ART care were similar to ART coverage for both CD4 of 200 and 350 over the study period.
ART coverage in the Rufiji district is unevenly distributed and far from the universal coverage target of 80%, in particular among young men. The findings in 2010 are close to the most recent estimates of ART coverage in 2013. To strive for universal coverage, both the recruitment of new eligible individuals to pre-ART and ART and the successful retention of those already on ART in the program need to be prioritized.
2004年10月，坦桑尼亚政府开始将其抗逆转录病毒治疗（ART）项目从转诊医院、地区医院和区级医院扩大至初级卫生保健机构。2010年，大多数抗逆转录病毒治疗诊所被下放到初级卫生机构。抗逆转录病毒治疗覆盖率，即接受联合治疗的艾滋病毒感染者（PLHIV）占需要治疗者的比例，为评估国家和地区层面抗逆转录病毒治疗项目的效率提供了依据。我们旨在评估2006年至2010年坦桑尼亚鲁菲季区按年龄和性别划分的成人抗逆转录病毒治疗及抗逆转录病毒治疗前护理覆盖率，CD4计数分别<200、<350以及所有艾滋病毒感染者。
抗逆转录病毒治疗及抗逆转录病毒治疗前护理的人数来自该地区护理和治疗中心按患者层面常规汇总的队列数据。我们使用ALPHA模型按年龄和性别预测CD4计数<200和<350时需要抗逆转录病毒治疗前护理及抗逆转录病毒治疗的人数。
艾滋病毒感染者中的成人抗逆转录病毒治疗覆盖率从2006年的2.9%增至2010年的17.6%。2010年，女性覆盖率为20%，男性为14.8%。按照CD4计数350和200的标准，2010年抗逆转录病毒治疗覆盖率分别为30.2%和38.7%。2010年，15 - 19岁和20 - 24岁年轻人的抗逆转录病毒治疗覆盖率分别为0和3.4%。2010年，35 - 39岁和40 - 44岁女性的抗逆转录病毒治疗覆盖率分别为30.6%和35%。CD4计数<350的艾滋病毒感染者成人抗逆转录病毒治疗前护理覆盖率从2006年的5%增至2010年的37.7%。在研究期间，抗逆转录病毒治疗前护理的年龄 - 性别覆盖率模式与CD4计数为200和350时的抗逆转录病毒治疗覆盖率相似。
鲁菲季区的抗逆转录病毒治疗覆盖率分布不均，远未达到80%的普遍覆盖目标，尤其是在年轻男性中。2010年的调查结果接近2013年抗逆转录病毒治疗覆盖率的最新估计值。为实现普遍覆盖，需要优先考虑招募新的符合条件者接受抗逆转录病毒治疗前护理及抗逆转录病毒治疗，并成功留住项目中已接受抗逆转录病毒治疗的患者。
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