Evangeli Michael, Newell Marie-Louise, McGrath Nuala
Department of Psychology, Royal Holloway University of London, Egham Hill, Egham, Surrey, London, TW20 0EX, UK.
Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa.
BMC Public Health. 2016 Apr 27;16:358. doi: 10.1186/s12889-016-3025-x.
Timely initiation of antiretroviral treatment (ART) requires sustained engagement in HIV care before treatment eligibility. We assessed loss to follow-up (LTFU) correlates in HIV-positive adults accessing HIV treatment and care, not yet ART-eligible (CD4 >500 cells/mm(3)).
This was a sub-study of a prospective cohort study (focusing on sexual behaviour) in an area of high HIV prevalence and widespread ART availability in rural KwaZulu-Natal, South Africa. Psychosocial, clinical and demographic data were collected at recruitment from individuals with CD4 >500 cells/mm(3). LTFU was defined as not attending clinic within 13 months of last visit or before death. Individuals starting ART were censored at ART initiation. Data were collected between January 2009 and January 2013. Analysis used Competing Risks regression.
Two hundred forty-seven individuals (212 females) were recruited (median follow-up 2.13 years, total follow-up 520.15 person-years). 86 remained in pre-ART care (34.8 %), 94 were LTFU (38.1 %), 58 initiated ART (23.5 %), 7 died (2.8 %), 2 transferred out (0.8 %). The LTFU rate was 18.07 per 100 person-years (95 % CI 14.76-21.12). LTFU before a competing event was 13.5 % at one and 34.4 % at three years. Lower LTFU rates were significantly associated with age (>37 versus ≤37 years: adjusted sub-Hazard ratio (aSHR) 0.51, 95 % CI 0.30-0.87), openness with family/friends (a little versus not at all, aSHR 0.81, 95 % CI 0.45-1.43; a lot versus not at all, aSHR 1.57, 95 % CI 0.94-2.62), children (0 versus 4+, aSHR 0.68, 95 % CI 0.24-1.87; 1 versus 4+, aSHR 2.05 95 % CI 1.14-3.69, 2 versus 4+; aSHR 1.71, 95 % CI 0.94-3.09; 3 versus 4a, aSHR 1.14, 95 % CI 0.57-2.30), previous CD4 counts (1 versus 0, aSHR 0.81, 95 % CI 0.45-1.43; 2+ versus 0, aSHR 0.43, 95 % CI 0.25-0.73), and most recent partner HIV status (not known versus HIV-positive, aSHR 0.77, 95 % CI 0.50-1.19; HIV-negative versus HIV-positive, aSHR 2.40, 95 % CI 1.18-4.88). The interaction between openness with family/friends and HIV partner disclosure was close to significance (p = 0.06). Those who had neither disclosed to partners nor were open with family/friends had lowest LTFU rates.
Strategies to retain younger people in pre-ART care are required. How openness with others, partner HIV status and disclosure, and children relate to LTFU needs further exploration.
及时启动抗逆转录病毒治疗（ART）需要在符合治疗条件之前持续接受HIV护理。我们评估了尚未符合ART治疗条件（CD4>500个细胞/mm³）的HIV阳性成年人失访（LTFU）的相关因素。
这是一项前瞻性队列研究（聚焦于性行为）的子研究，该研究在南非夸祖鲁-纳塔尔省农村地区进行，该地区HIV感染率高且广泛提供ART。在招募时收集了CD4>500个细胞/mm³个体的心理社会、临床和人口统计学数据。LTFU定义为在最后一次就诊后13个月内未就诊或在死亡前未就诊。开始接受ART治疗的个体在开始ART治疗时被截尾。数据收集时间为2009年1月至2013年1月。分析采用竞争风险回归。
招募了247名个体（212名女性）（中位随访2.13年，总随访520.15人年）。86人仍在接受ART前护理（34.8%），94人失访（38.1%），58人开始接受ART治疗（23.5%），7人死亡（2.8%），2人转出（0.8%）。LTFU率为每100人年18.07例（95%CI 14.76 - 21.12）。在发生竞争事件之前，1年时LTFU率为13.5%，3年时为34.4%。较低的LTFU率与年龄（＞37岁与≤37岁：调整后亚风险比（aSHR）0.51，95%CI 0.30 - 0.87）、与家人/朋友的坦诚程度（有点坦诚与完全不坦诚，aSHR 0.81，95%CI 0.45 - 1.43；非常坦诚与完全不坦诚，aSHR 1.57，95%CI 0.94 - 2.62）、子女情况（0个与4个以上，aSHR 0.68，95%CI 0.24 - 1.87；1个与4个以上，aSHR 2.05，95%CI 1.14 - 3.69；2个与4个以上，aSHR 1.71，95%CI 0.94 - 3.09；3个与4个以上，aSHR 1.14，95%CI 0.57 - 2.30）、之前的CD4计数（1次与0次，aSHR 0.81，95%CI 0.45 - 1.43；2次及以上与0次，aSHR 0.43，95%CI 0.25 - 0.73）以及最近性伴侣的HIV感染状况（未知与HIV阳性，aSHR 0.77，95%CI 0.50 - 1.19；HIV阴性与HIV阳性，aSHR 2.40，95%CI 1.18 - 4.88）显著相关。与家人/朋友的坦诚程度和向性伴侣披露HIV感染状况之间的交互作用接近显著（p = 0.06）。既未向性伴侣披露也未与家人/朋友坦诚相待的人LTFU率最低。
需要制定策略以使年轻人留在ART前护理中。与他人的坦诚程度、性伴侣的HIV感染状况及披露情况以及子女情况与LTFU之间的关系需要进一步探索。
