O'Laughlin K N, Kasozi J, Rabideau D J, Parker R A, Mulogo E, Faustin Z M, Greenwald K E, Doraiswamy S, Walensky R P, Bassett I V
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Department of Medicine, Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA.
HIV Med. 2017 Aug;18(7):513-518. doi: 10.1111/hiv.12476. Epub 2017 Jan 10.
Refugees living in Uganda come from HIV-endemic countries, and many remain in refugee settlements for over a decade. Our objective was to evaluate the HIV care cascade in Nakivale Refugee Settlement and to assess correlates of linkage to care.
We prospectively enrolled individuals accessing clinic-based HIV testing in Nakivale Refugee Settlement from March 2013 to July 2014. Newly HIV-diagnosed clients were followed for 3 months post-diagnosis. Clients underwent a baseline survey. The following outcomes were obtained from HIV clinic registers in Nakivale: clinic attendance ('linkage to HIV care'), CD4 testing, antiretroviral therapy (ART) eligibility, and ART initiation within 90 days of testing. Descriptive data were reported as frequency with 95% confidence interval (CI) or median with interquartile range (IQR). The impact of baseline variables on linkage to care was assessed with logistic regression models.
Of 6850 adult clients tested for HIV, 276 (4%; CI: 3-5%) were diagnosed with HIV infection, 148 (54%; CI: 47-60%) of those were linked to HIV care, 54 (20%; CI: 15-25%) had a CD4 test, 22 (8%; CI: 5-12%) were eligible for ART, and 17 (6%; CI: 3-10%) initiated ART. The proportions of refugees and nationals at each step of the cascade were similar. We identified no significant predictors of linkage to care.
Less than a quarter of newly HIV-diagnosed clients completed ART assessment, considerably lower than in other reports from sub-Saharan Africa. Understanding which factors hinder linkage to and engagement in care in the settlement will be important to inform interventions specific for this environment.
生活在乌干达的难民来自艾滋病高发国家，许多人在难民营中停留超过十年。我们的目的是评估纳基瓦莱难民营中的艾滋病护理流程，并评估与获得护理相关的因素。
我们前瞻性地纳入了2013年3月至2014年7月在纳基瓦莱难民营中接受基于诊所的艾滋病检测的个体。新诊断出感染艾滋病的患者在诊断后随访3个月。患者接受了基线调查。从纳基瓦莱的艾滋病诊所登记册中获取以下结果：诊所就诊情况（“与艾滋病护理的联系”）、CD4检测、抗逆转录病毒治疗（ART）资格以及检测后90天内开始接受ART治疗的情况。描述性数据以频率加95%置信区间（CI）或中位数加四分位间距（IQR）的形式报告。使用逻辑回归模型评估基线变量对获得护理的影响。
在6850名接受艾滋病检测的成年患者中，276人（4%；CI：3 - 5%）被诊断出感染艾滋病，其中148人（54%；CI：47 - 60%）与艾滋病护理建立了联系，54人（20%；CI：15 - 25%）进行了CD4检测，22人（8%；CI：5 - 12%）符合ART治疗条件，17人（6%；CI：3 - 10%）开始接受ART治疗。在护理流程的每个步骤中，难民和本国居民的比例相似。我们没有发现与获得护理相关的显著预测因素。
新诊断出感染艾滋病的患者中，不到四分之一完成了ART评估，这一比例远低于撒哈拉以南非洲的其他报告。了解哪些因素阻碍在该难民营中获得护理并参与护理，对于制定针对该环境的具体干预措施非常重要。
