Kelly J Daniel, Schlough Gabriel Warren, Conteh Sulaiman, Barrie M Bailor, Kargbo Brima, Giordano Thomas P
Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America.
Wellbody Alliance, Koidu Town, Sierra Leone.
PLoS One. 2016 Feb 22;11(2):e0149584. doi: 10.1371/journal.pone.0149584. eCollection 2016.
The heterogeneity of the pre-antiretroviral (pre-ART) population calls for more granular depictions of the cascade of HIV care.
We studied a prospective cohort of persons newly diagnosed with HIV infection from a single center in Freetown, Sierra Leone, over a 12-month period and then traced those persons who were lost to follow-up (LTFU) during pre-ART care (before ART initiation). ART eligibility was based on a CD4 cell count result of ≤ 350 mm/cells and/or WHO clinical stage 3 or 4. Persons who attended an appointment in the final three months were considered to be retained in care. Adherence to ART was measured using pharmacy refill dates. "Effective HIV care" was defined as completion of the cascade of care at 12-months regardless of whether patients are on ART. Tracing outcomes were obtained for those who were LTFU during pre-ART care.
408 persons newly diagnosed with HIV infection were screened, 338 were enrolled, and 255 persons were staged for ART. ART-ineligible persons had higher retention rates than ART-eligible persons (59.6% vs 41.8%, p = 0.03). 77 (22.8%) of 338 persons received effective HIV care. Most attrition (61.9%) occurred with persons during pre-ART care. 123 of 138 persons (89.1%) who were LTFU prior to ART initiation were found, and 91 of those 123 (74.0%) were alive. Of the 74 persons who were alive and described their engagement in care, 40 (54.1%) stopped care. Nearly half (42.5%) of those 40 stopped after assessment of ART-eligibility but before ART initiation. The main limitation of this study was the lack of tracing outcomes for those lost during ART care.
The majority of the pre-ART LTFU population stopped their care, particularly after ART-eligibility but before ART initiation. Interventions to hasten ART initiation and retain this at-risk group may have significant downstream impact on effective HIV care.
抗逆转录病毒治疗前（pre-ART）人群的异质性要求对艾滋病病毒治疗流程进行更细致的描述。
我们研究了来自塞拉利昂弗里敦一个单一中心的新诊断出感染艾滋病病毒的前瞻性队列人群，为期12个月，然后追踪那些在抗逆转录病毒治疗前护理期间（开始抗逆转录病毒治疗之前）失访的人。开始抗逆转录病毒治疗的资格基于CD4细胞计数结果≤350个/mm³细胞和/或世界卫生组织临床分期3或4期。在最后三个月参加预约的人被视为继续接受护理。使用药房配药日期来衡量对抗逆转录病毒治疗的依从性。“有效的艾滋病病毒护理”定义为在12个月时完成护理流程，无论患者是否接受抗逆转录病毒治疗。获得了抗逆转录病毒治疗前护理期间失访者的追踪结果。
对408名新诊断出感染艾滋病病毒的人进行了筛查，338人被纳入研究，255人被确定开始抗逆转录病毒治疗。不符合抗逆转录病毒治疗条件的人的留存率高于符合条件的人（59.6%对41.8%，p = 0.03）。338人中77人（22.8%）接受了有效的艾滋病病毒护理。大多数人员流失（61.9%）发生在抗逆转录病毒治疗前护理期间。在开始抗逆转录病毒治疗前失访的138人中找到了123人（89.1%），其中123人中91人（74.0%）还活着。在74名活着并描述其接受护理情况的人中，40人（54.1%）停止了护理。这40人中近一半（42.5%）在评估抗逆转录病毒治疗资格后但在开始抗逆转录病毒治疗前停止了护理。本研究的主要局限性是缺乏对抗逆转录病毒治疗护理期间失访者的追踪结果。
抗逆转录病毒治疗前失访人群中的大多数停止了护理，特别是在符合抗逆转录病毒治疗资格后但在开始抗逆转录病毒治疗前。加快开始抗逆转录病毒治疗并留住这一高危人群的干预措施可能会对有效的艾滋病病毒护理产生重大的下游影响。
