Bucciardini Raffaella, Fragola Vincenzo, Abegaz Teshome, Lucattini Stefano, Halifom Atakilt, Tadesse Eskedar, Berhe Micheal, Pugliese Katherina, Binelli Andrea, De Castro Paola, Terlizzi Roberta, Fucili Luca, Di Gregorio Massimiliano, Mirra Marco, Olivieri Erika, Teklu Tsigemariam, Zegeye Teame, Haile Amanuel, Vella Stefano, Abraham Loko, Godefay Hagos
Istituto Superiore di Sanità, Rome, Italy.
College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
PLoS One. 2015 Sep 4;10(9):e0136117. doi: 10.1371/journal.pone.0136117. eCollection 2015.
Although Ethiopia has been scaling up the antiretroviral therapy (ART) services, low retention in care of patients remains one of the main obstacles to treatment success. We report data on retention in care and its associated determinants in Tigray, Ethiopia.
We used data from the CASA project, a prospective observational and multi-site study of a cohort of HIV-infected patients who initiated ART for the first time in Tigray. Four participating health facilities (HFs) located in the South of Tigray were considered for this study. Patients were followed for one year after ART initiation. The main outcome measure was represented by the current retention in care, defined as the proportion of patients who were alive and receiving ART at the same HF one year after ART initiation. Patients who started ART between January 1, 2013 and December 31, 2013 were included in this analysis. Patients were followed for one year after ART initiation. The determinants of retention were analysed using univariate and multivariate Cox Proportional Hazards model with robust sandwich estimates to account for within HF correlation.
The four participating HFs in Tigray were able to retain overall 85.1% of their patients after one year from starting ART. Loss to follow-up (5.5%) and transfers to other HF (6.6) were the main determinant of attrition. A multivariate analysis shows that the factors significantly associated with retention were the type of HF, gender and active TB. Alamata health center was the HF with the highest attrition rate (HR 2.99, 95% CI: 2.77-3.23). Active TB (HR 1.72, 95% CI: 1.23-2.41) and gender (HR 1.64, 95% CI: 1.10-2.56) were also significantly associated with attrition.
Although Ethiopia has significantly improved access to the ART program, achieving and maintaining a satisfactory long-term retention rate is a future goal. This is difficult because of different retention rates among HFs. Moreover specific interventions should be directed to people of different sex to improve retention in care in male population.
尽管埃塞俄比亚一直在扩大抗逆转录病毒疗法（ART）服务，但患者护理留存率低仍然是治疗成功的主要障碍之一。我们报告了埃塞俄比亚提格雷地区护理留存率及其相关决定因素的数据。
我们使用了CASA项目的数据，这是一项对提格雷地区首次开始接受抗逆转录病毒治疗的艾滋病毒感染患者队列进行的前瞻性观察性多地点研究。本研究纳入了位于提格雷南部的四个参与研究的医疗机构（HFs）。患者在开始接受抗逆转录病毒治疗后随访一年。主要结局指标为当前护理留存率，定义为开始接受抗逆转录病毒治疗一年后在同一医疗机构存活并接受抗逆转录病毒治疗的患者比例。本分析纳入了2013年1月1日至2013年12月31日期间开始接受抗逆转录病毒治疗的患者。患者在开始接受抗逆转录病毒治疗后随访一年。使用单变量和多变量Cox比例风险模型以及稳健的三明治估计来分析留存率的决定因素，以考虑医疗机构内部的相关性。
提格雷地区的四个参与研究的医疗机构在开始接受抗逆转录病毒治疗一年后，总体上能够留存85.1%的患者。失访（5.5%）和转至其他医疗机构（6.6%）是患者流失的主要决定因素。多变量分析表明，与留存率显著相关的因素包括医疗机构类型、性别和活动性结核病。阿拉马塔健康中心是流失率最高的医疗机构（风险比2.99，95%置信区间：2.77 - 3.23）。活动性结核病（风险比1.72，95%置信区间：1.23 - 2.41）和性别（风险比1.64，95%置信区间：1.10 - 2.56）也与患者流失显著相关。
尽管埃塞俄比亚在抗逆转录病毒治疗项目的可及性方面有了显著改善，但实现并维持令人满意的长期留存率是未来的一个目标。由于不同医疗机构的留存率不同，这一目标颇具难度。此外，应针对不同性别的人群采取特定干预措施，以提高男性人群的护理留存率。
