Koenig Serena P, Bernard Daphne, Dévieux Jessy G, Atwood Sidney, McNairy Margaret L, Severe Patrice, Marcelin Adias, Julma Pierrot, Apollon Alexandra, Pape Jean W
Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.
Division of Global Health Equity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America.
PLoS One. 2016 Feb 22;11(2):e0146903. doi: 10.1371/journal.pone.0146903. eCollection 2016.
High attrition during the period from HIV testing to antiretroviral therapy (ART) initiation is widely reported. Though treatment guidelines have changed to broaden ART eligibility and services have been widely expanded over the past decade, data on the temporal trends in pre-ART outcomes are limited; such data would be useful to guide future policy decisions.
We evaluated temporal trends and predictors of retention for each step from HIV testing to ART initiation over the past decade at the GHESKIO clinic in Port-au-Prince Haiti. The 24,925 patients >17 years of age who received a positive HIV test at GHESKIO from March 1, 2003 to February 28, 2013 were included. Patients were followed until they remained in pre-ART care for one year or initiated ART.
24,925 patients (61% female, median age 35 years) were included, and 15,008 (60%) had blood drawn for CD4 count within 12 months of HIV testing; the trend increased over time from 36% in Year 1 to 78% in Year 10 (p<0.0001). Excluding transfers, the proportion of patients who were retained in pre-ART care or initiated ART within the first year after HIV testing was 84%, 82%, 64%, and 64%, for CD4 count strata ≤200, 201 to 350, 351 to 500, and >500 cells/mm3, respectively. The trend increased over time for each CD4 strata, and in Year 10, 94%, 95%, 79%, and 74% were retained in pre-ART care or initiated ART for each CD4 strata. Predictors of pre-ART attrition included male gender, low income, and low educational status. Older age and tuberculosis (TB) at HIV testing were associated with retention in care.
The proportion of patients completing assessments for ART eligibility, remaining in pre-ART care, and initiating ART have increased over the last decade across all CD4 count strata, particularly among patients with CD4 count ≤350 cells/mm3. However, additional retention efforts are needed for patients with higher CD4 counts.
从艾滋病毒检测到开始抗逆转录病毒治疗（ART）期间的高流失率已被广泛报道。尽管治疗指南已有所改变以扩大ART的适用范围，并且在过去十年中服务也得到了广泛扩展，但关于ART治疗前结果的时间趋势数据有限；此类数据将有助于指导未来的政策决策。
我们评估了过去十年中在海地太子港的GHESKIO诊所从艾滋病毒检测到开始ART治疗的每个步骤的时间趋势和留存率预测因素。纳入了2003年3月1日至2013年2月28日在GHESKIO接受艾滋病毒检测呈阳性的24925名17岁以上患者。对患者进行随访，直到他们在ART治疗前护理中持续一年或开始接受ART治疗。
纳入了24925名患者（61%为女性，中位年龄35岁），其中15008名（60%）在艾滋病毒检测后12个月内进行了CD4细胞计数检测；这一比例随时间从第1年的36%增加到第10年的78%（p<0.0001）。排除转诊患者后，在艾滋病毒检测后第一年内留在ART治疗前护理或开始接受ART治疗的患者比例，CD4细胞计数≤200、201至350、351至500和>500个细胞/mm³分层的分别为84%、82%、64%和64%。每个CD4分层的这一比例随时间增加，在第10年，每个CD4分层中94%、95%、79%和74%的患者留在ART治疗前护理或开始接受ART治疗。ART治疗前流失的预测因素包括男性、低收入和低教育水平。年龄较大以及艾滋病毒检测时患有结核病（TB）与持续接受护理相关。
在过去十年中，所有CD4细胞计数分层中，完成ART治疗资格评估、留在ART治疗前护理以及开始接受ART治疗的患者比例均有所增加，尤其是在CD4细胞计数≤350个细胞/mm³的患者中。然而，CD4细胞计数较高的患者还需要额外的留存努力。
