谁会失访？识别马拉维有失访风险的患者。DREAM项目经验。

Who will be lost? Identifying patients at risk of loss to follow-up in Malawi. The DREAM Program Experience.

作者信息

Mancinelli S, Nielsen-Saines K, Germano P, Guidotti G, Buonomo E, Scarcella P, Lunghi R, Sangare H, Orlando S, Liotta G, Marazzi M C, Palombi L

机构信息

Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.

Department of Pediatrics-Infectious Disease, University of California Los Angeles, Los Angeles, CA, USA.

出版信息

HIV Med. 2017 Sep;18(8):573-579. doi: 10.1111/hiv.12492. Epub 2017 Feb 2.

DOI:10.1111/hiv.12492

PMID:28150466

Abstract

OBJECTIVES

Retention of subjects in HIV treatment programmes is crucial for the success of treatment. We evaluated retention/loss to follow-up (LTFU) in subjects receiving established care in Malawi.

METHODS

Data for HIV-positive patients registered in Drug Resource Enhancement Against AIDS and Malnutrition centres in Malawi prior to 2014 were reviewed. Visits entailing HIV testing/counselling, laboratory evaluations, nutritional evaluation/supplementation, community support, peer education, and antiretroviral (ART) monitoring/pharmacy were noted. LTFU was defined as > 90 days without an encounter. Parameters potentially associated with LTFU were explored, with univariate/multivariate logistic regression analyses being performed.

RESULTS

Fifteen thousand and ninety-nine patients registered before 2014; 202 (1.3%) were lost to follow-up (LTFU) (1.3%). Nine (0.5%) of 1744 paediatric patients were LTFU vs. 1.4% (n = 193) of 13 355 adults (P < 0.001). Subjects who were LTFU had fewer days in care than retained subjects (1338 vs. 1544, respectively; P < 0.001) and a longer duration of ART (1530 vs. 1300 days, respectively; P < 0.001). Subjects who were LTFU had higher baseline HIV viral loads (P = 0.016) and higher body mass indexes (P < 0.001), were more likely to live in urban settings (88% of patients who were LTFU lived in urban settings) with better housing [relative risk (RR) 2.3; 95% confidence interval (CI) 1.67-3.09; P < 0.001], and were more likely to be educated (RR 1.88; 95% CI 1.42-2.50; P < 0.001). Distance to the centre and cost of transportation were associated with LTFU (RR 3.4; 95% CI 2.84-5.37; P < 0.001), as was absence of a maternal figure (RR 1.57; 95% CI 1.17-2.09; P < 0.001). Viral load, distance index, education and a maternal figure were predictive of LTFU.

CONCLUSIONS

Educated, urbanized HIV-infected adults living far from programme centres are at high risk of LTFU, particularly if there is no maternal figure in the household. These variables must be taken into consideration when developing retention strategies.

摘要

目的

在艾滋病治疗项目中留住受试者对于治疗的成功至关重要。我们评估了马拉维接受既定治疗的受试者的留存率/失访率（LTFU）。

方法

回顾了2014年之前在马拉维抗艾滋病和营养不良药物资源增强中心登记的HIV阳性患者的数据。记录了涉及HIV检测/咨询、实验室评估、营养评估/补充、社区支持、同伴教育以及抗逆转录病毒（ART）监测/配药的就诊情况。失访定义为超过90天无就诊记录。探讨了可能与失访相关的参数，并进行了单因素/多因素逻辑回归分析。

结果

2014年之前登记了15099名患者；202名（1.3%）失访（失访率为1.3%）。1744名儿科患者中有9名（0.5%）失访，而13355名成人中有193名（1.4%）失访（P<0.001）。失访的受试者接受治疗的天数比留存的受试者少（分别为1338天和1544天；P<0.001），且接受抗逆转录病毒治疗的时间更长（分别为1530天和1300天；P<0.001）。失访的受试者基线HIV病毒载量更高（P=0.016），体重指数更高（P<0.001），更有可能居住在城市地区（失访患者中有88%居住在城市地区），住房条件更好[相对风险（RR）为2.3；95%置信区间（CI）为1.67 - 3.09；P<0.001]，并且更有可能受过教育（RR为1.88；95%CI为1.42 - 2.50；P<0.001）。到中心的距离和交通成本与失访相关（RR为3.4；95%CI为2.84 - 5.37；P<0.001），没有母亲角色也与失访相关（RR为1.57；95%CI为1.17 - 2.09；P<0.001）。病毒载量、距离指数、教育程度和母亲角色可预测失访情况。