Mecha Jared O, Kubo Elizabeth N, Nganga Lucy W, Muiruri Peter N, Njagi Lilian N, Mutisya Immaculate N, Odionyi Justine J, Ilovi Syokau C, Wambui Mary, Githu Christopher, Ngethe Richard, Obimbo Elizabeth M, Ngumi Zipporah W
Department of Clinical Medicine and Therapeutics, University of Nairobi School of Medicine, Nairobi, Kenya.
The Palladium Group, Nairobi, Kenya.
AIDS Res Ther. 2016 Nov 14;13:38. doi: 10.1186/s12981-016-0122-y. eCollection 2016.
The success of antiretroviral therapy in resource-scarce settings is an illustration that complex healthcare interventions can be successfully delivered even in fragile health systems. Documenting the success factors in the scale-up of HIV care and treatment in resource constrained settings will enable health systems to prepare for changing population health needs. This study describes changing demographic and clinical characteristics of adult pre-ART cohorts, and identifies predictors of pre-ART attrition at a large urban HIV clinic in Nairobi, Kenya.
We conducted a retrospective cohort analysis of data on HIV infected adults (≥15 years) enrolling in pre-ART care between January 2004 and September 2015. Attrition (loss to program) was defined as those who died or were lost to follow-up (having no contact with the facility for at least 6 months). We used Kaplan-Meier survival analysis to determine time to event for the different modes of transition, and Cox proportional hazards models to determine predictors of pre-ART attrition.
Over the 12 years of observation, there were increases in the proportions of young people (age 15 to 24 years); and patients presenting with early disease (by WHO clinical stage and higher median CD4 cell counts), p = 0.0001 for trend. Independent predictors of attrition included: aHR (95% CI): male gender 1.98 (1.69-2.33), p = 0.0001; age 20-24 years 1.80 (1.37-2.37), p = 0.0001), or 25-34 years 1.22 (1.01-1.47), p = 0.0364; marital status single 1.55 (1.29-1.86), p = 0.0001) or divorced 1.41(1.02-1.95), p = 0.0370; urban residency 1.83 (1.40-2.38), p = 0.0001; CD4 count of 0-100 cells/µl 1.63 (1.003-2.658), p = 0.0486 or CD4 count >500 cells/µl 2.14(1.46-3.14), p = 0.0001.
In order to optimize the impact of HIV prevention, care and treatment in resource scarce settings, there is an urgent need to implement prevention and treatment interventions targeting young people and patients entering care with severe immunosuppression (CD4 cell counts <100 cells/µl). Additionally, care and treatment programmes should strengthen inter-facility referrals and linkages to improve care coordination and prevent leakages in the HIV care continuum.
在资源匮乏地区抗逆转录病毒疗法的成功表明，即使在脆弱的卫生系统中，复杂的医疗保健干预措施也能够成功实施。记录在资源受限环境中扩大艾滋病毒护理和治疗的成功因素，将使卫生系统能够为满足不断变化的人群健康需求做好准备。本研究描述了成人抗逆转录病毒治疗前队列不断变化的人口统计学和临床特征，并确定了肯尼亚内罗毕一家大型城市艾滋病毒诊所抗逆转录病毒治疗前失访的预测因素。
我们对2004年1月至2015年9月期间开始接受抗逆转录病毒治疗前护理的艾滋病毒感染成人（≥15岁）的数据进行了回顾性队列分析。失访（退出项目）定义为死亡或失访（与医疗机构至少6个月无接触）的患者。我们使用Kaplan-Meier生存分析来确定不同转变模式的事件发生时间，并使用Cox比例风险模型来确定抗逆转录病毒治疗前失访的预测因素。
在12年的观察期内，年轻人（15至24岁）的比例有所增加；以及疾病早期患者（根据世界卫生组织临床分期和更高的CD4细胞计数中位数），趋势p = 0.0001。失访的独立预测因素包括：调整后风险比（95%置信区间）：男性1.98（1.69 - 2.33），p = 0.0001；20 - 24岁1.80（1.37 - 2.37），p = 0.0001），或25 - 34岁1.22（1.01 - 1.47），p = 0.0364；婚姻状况为单身1.55（1.29 - 1.86），p = 0.0001）或离婚1.41（1.02 - 1.95），p = 0.0364；城市居住1.83（1.40 - 2.38），p = 0.0001；CD4细胞计数为0 - 100个/微升1.63（1.003 - 2.658），p = 0.0486或CD4细胞计数>500个/微升2.14（1.46 - 3.14），p = 0.0001。
为了在资源匮乏地区优化艾滋病毒预防、护理和治疗的效果，迫切需要针对年轻人以及进入护理时伴有严重免疫抑制（CD4细胞计数<100个/微升）的患者实施预防和治疗干预措施。此外，护理和治疗项目应加强机构间转诊和联系，以改善护理协调并防止艾滋病毒护理连续过程中的漏失。
