McGettrick P, Ghavami-Kia B, Tinago W, Macken A, O'Halloran J, Lambert J S, Sheehan G, Mallon P W G
a HIV Molecular Research Group , School of Medicine, University College Dublin , Dublin , Ireland.
b Department of Infectious Diseases , Mater Misericordae University Hospital , Dublin , Ireland.
HIV Clin Trials. 2017 May;18(3):93-99. doi: 10.1080/15284336.2017.1298317. Epub 2017 Mar 14.
The HIV Care Cascade model can be used to measure how clinical services align with United Nations' (UN) HIV treatment targets. Previous models have highlighted sequential losses at each step of the Cascade with a significant proportion being not retained in care (NRIC).
We aimed to assess the feasibility of meeting the UN targets and assess factors associated with, and calculate the true proportion of those, NRIC.
All people living with HIV who were linked to our service, one of three specialist HIV care providers in Dublin Ireland, from its establishment in 1993 to 1 December 2014, were included in the cohort and were categorized as linked to care, retained in care (RIC), on antiretroviral therapy (on ART), virally suppressed (HIV RNA <40copies/ml), and NRIC. An analysis of those NRIC was performed to categorize their current status through direct/indirect contact.
Of 1000 patients linked to care, 78.7% (n = 787) were RIC, of whom 91.5% (n = 720) were on ART, with 89.9% (n = 644) virally suppressed. Those RIC were more likely older (p = 0.006) and non-IVDU (p < 0.001). Of 213 (21.3%) NRIC, 56 (26.3%) emigrated, 27 (12.7%) transferred care, 15 (7.0%) stopped attending but were contactable, 38 (17.8%) died, and 77 (36.1%) were lost to follow-up. After revision, 10.5% of the cohort was confirmed as NRIC, with 6 of 15 defined as "stopped attending" re-linked to care following direct contact.
Our HIV Care Cascade model demonstrates that the true numbers of patients NRIC may be significantly lower than previously estimated and once RIC, treatment goals approaching the United Nations Programme on HIV and AIDS targets are possible with 91.5% on treatment and almost 90% of those on treatment virally suppressed. That 40% reengaged following direct contact suggests benefit through regular monitoring and direct contact based on the HIV Care Cascade model.
艾滋病病毒关怀连续统一体模型可用于衡量临床服务与联合国艾滋病治疗目标的契合程度。以往的模型强调了连续统一体各步骤中的连续流失情况，其中很大一部分人未保留在关怀体系中（NRIC）。
我们旨在评估实现联合国目标的可行性，评估与NRIC相关的因素，并计算NRIC的实际比例。
所有与我们服务机构建立联系的艾滋病病毒感染者均纳入该队列，我们的服务机构是爱尔兰都柏林三家专业艾滋病病毒关怀服务机构之一，时间跨度为1993年机构成立至2014年12月1日。这些感染者被分类为与关怀体系建立联系、保留在关怀体系中（RIC）、接受抗逆转录病毒治疗（接受ART）、病毒得到抑制（艾滋病病毒核糖核酸<40拷贝/毫升）以及未保留在关怀体系中（NRIC）。对那些未保留在关怀体系中的人进行分析，通过直接/间接接触对他们的当前状态进行分类。
在1000名与关怀体系建立联系的患者中，78.7%（n = 787）为保留在关怀体系中，其中91.5%（n = 720）接受ART治疗，89.9%（n = 644）病毒得到抑制。那些保留在关怀体系中的患者年龄较大（p = 0.006）且不是注射吸毒者（p < 0.001）的可能性更大。在213名（21.3%）未保留在关怀体系中的患者中，56名（26.3%）移民，27名（12.7%）转诊，15名（7.0%）停止就诊但仍可联系上，38名（17.8%）死亡，77名（36.1%）失访。经过重新评估，该队列中有10.5%被确认为未保留在关怀体系中，15名被定义为“停止就诊”的患者中有6名在直接接触后重新与关怀体系建立了联系。
我们的艾滋病病毒关怀连续统一体模型表明，未保留在关怀体系中的患者实际数量可能比之前估计的要低得多，一旦保留在关怀体系中，接近联合国艾滋病规划署目标的治疗目标是有可能实现的，91.5%的患者接受治疗，接受治疗的患者中近90%病毒得到抑制。40%的患者在直接接触后重新参与进来，这表明基于艾滋病病毒关怀连续统一体模型进行定期监测和直接接触是有益的。
