Teshome Wondu, Belayneh Mehretu, Moges Mathewos, Mekonnen Emebet, Endrias Misganu, Ayele Sinafiksh, Misganaw Tebeje, Shiferaw Mekonnen, Tesema Tigist
School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia.
Health Research and Technology Transfer Support Process, Southern Nations Nationalities and Peoples' Regional Health Bureau, Hawassa, Ethiopia.
HIV AIDS (Auckl). 2015 May 28;7:167-74. doi: 10.2147/HIV.S85440. eCollection 2015.
Decentralization and task shifting has significantly improved access to antiretroviral therapy (ART). Many studies conducted to determine the attrition rate in Ethiopia have not compared attrition rates between hospitals and health centers in a relatively recent cohort of patients. This study compared death and loss to follow-up (LTFU) rates among ART patients in hospitals and health centers in south Ethiopia.
Data routinely collected from patients aged older than 15 years who started ART between July 2011 and August 2012 in 20 selected health facilities (12 being hospitals) were analyzed. The outcomes of interest were LTFU and death. The data were entered, cleaned, and analyzed using Statistical Package for the Social Sciences version 20.0 and Stata version 12.0. Competing-risk regression models were used.
The service years of the facilities were similar (median 8 and 7.5 for hospitals and health centers, respectively). The mean patient age was 33.7±9.6 years. The median baseline CD4 count was 179 (interquartile range 93-263) cells/mm(3). A total of 2,356 person-years of observation were made with a median follow-up duration of 28 (interquartile range 22-31) months; 24.6% were either dead or LTFU, resulting in a retention rate of 75.4%. The death rates were 3.0 and 1.5 and the LTFU rate were 9.0 and 10.9 per 100 person-years of observation in health centers and hospitals, respectively. The competing-risk regression model showed that the gap between testing and initiation of ART, body mass index, World Health Organization clinical stage, isoniazid prophylaxis, age, facility type, and educational status were independently associated with LTFU. Moreover, baseline tuberculous disease, poor functional status, and follow-up at a health center were associated with an elevated probability of death.
We observed a higher death rate and a lower LTFU rate in health centers than in hospitals. Most of the associated variables were also previously documented. Higher LTFU was noticed for patients with a smaller gap between testing and initiation of treatment.
权力下放和任务转移显著改善了抗逆转录病毒疗法（ART）的可及性。许多旨在确定埃塞俄比亚患者流失率的研究并未在相对近期的患者队列中比较医院和健康中心之间的流失率。本研究比较了埃塞俄比亚南部医院和健康中心接受抗逆转录病毒治疗患者的死亡率和失访率。
对2011年7月至2012年8月期间在20家选定医疗机构（其中12家为医院）开始接受抗逆转录病毒治疗的15岁以上患者常规收集的数据进行分析。感兴趣的结局为失访和死亡。数据使用社会科学统计软件包20.0版和Stata 12.0版录入、清理并分析。采用竞争风险回归模型。
各医疗机构的服务年限相似（医院和健康中心的中位数分别为8年和7.5年）。患者平均年龄为33.7±9.6岁。基线CD4细胞计数中位数为179（四分位间距93 - 263）个/mm³。共进行了2356人年的观察，中位随访时间为28（四分位间距22 - 31）个月；24.6%的患者死亡或失访，留存率为75.4%。健康中心和医院每100人年观察的死亡率分别为3.0和1.5，失访率分别为9.0和10.9。竞争风险回归模型显示，抗逆转录病毒治疗检测与开始治疗之间的间隔、体重指数、世界卫生组织临床分期、异烟肼预防用药、年龄、医疗机构类型和教育程度与失访独立相关。此外，基线结核病、功能状态差以及在健康中心接受随访与死亡概率升高相关。
我们观察到健康中心的死亡率高于医院，失访率低于医院。大多数相关变量此前也有记录。治疗检测与开始治疗间隔较小的患者失访率较高。
