Davies Mary-Ann, Tsondai Priscilla, Tiffin Nicki, Eley Brian, Rabie Helena, Euvrard Jonathan, Orrell Catherine, Prozesky Hans, Wood Robin, Cogill Dolphina, Haas Andreas D, Sohn Annette H, Boulle Andrew
Centre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Western Cape Province Department of Health, Health Impact Assessment Directorate, Cape Town, South Africa.
J Int AIDS Soc. 2017 May 16;20(Suppl 3):21668. doi: 10.7448/IAS.20.4.21668.
To evaluate long-term outcomes in HIV-infected adolescents, it is important to identify ways of tracking outcomes after transfer to a different health facility. The Department of Health (DoH) in the Western Cape Province (WCP) of South Africa uses a single unique identifier for all patients across the health service platform. We examined adolescent outcomes after transfer by linking data from four International epidemiology Databases to Evaluate AIDS Southern Africa (IeDEA-SA) cohorts in the WCP with DoH data.
We included adolescents on antiretroviral therapy who transferred out of their original cohort from 10 to 19 years of age between 2004 and 2014. The DoH conducted the linkage separately for each cohort and linked anonymized data were then combined. The primary outcome was successful transfer defined as having a patient record at a facility other than the original facility after the transfer date. Secondary outcomes included the proportion of patients retained, with HIV-RNA <400 copies/ml and CD4 > 500 cells/µl at 1, 2 and 3 years post-transfer.
Of 460 adolescents transferred out (53% female), 72% transferred at 10-14 years old, and 79% transferred out of tertiary facilities. Overall, 81% of patients transferred successfully at a median (interquartile range) of 56 (27-134) days following transfer date; 95% reached the transfer site <18 months after transfer out. Among those transferring successfully, the proportion retained decreased from 1 to 3 years post-transfer (90-84%). There was no significant difference between transfer and 1-3 years post-transfer in the proportion of retained adolescents with HIV-RNA <400 copies/ml and CD4 > 500 cells/µl except for HIV-RNA <400 copies/ml at 3 years (86% vs. 75%; = 0.007). The proportion virologically suppressed and with CD4 > 500 cells/µl was significantly lower at 1 and 2 years post-transfer in those transferring at 15-19 vs. 10-14 years of age. Using laboratory data alone over-estimated time to successful transfer.
Linking cohort data to health information system data allowed efficient assessment of post-transfer outcomes. Although >80% of adolescents transferred successfully with nearly 85% of them retained for 3 years post-transfer, the decline in the proportion virologically suppressed and poorer outcomes in older adolescents are concerns..
为了评估感染艾滋病病毒的青少年的长期结局，确定在转至不同医疗机构后追踪结局的方法很重要。南非西开普省卫生部在整个卫生服务平台为所有患者使用单一的唯一标识符。我们通过将西开普省四个国际艾滋病流行病学数据库评估南部非洲（IeDEA-SA）队列的数据与卫生部数据相链接，研究了转院后的青少年结局。
我们纳入了2004年至2014年间年龄在10至19岁之间转出其原队列的接受抗逆转录病毒治疗的青少年。卫生部对每个队列分别进行链接，然后将匿名数据合并。主要结局是成功转院，定义为在转院日期后在原医疗机构以外的机构有患者记录。次要结局包括转院后1年、2年和3年时病毒载量<400拷贝/ml且CD4>500细胞/μl的患者留存比例。
在转出的460名青少年中（53%为女性）,72%在10至14岁时转院，79%从三级医疗机构转出。总体而言，81%的患者在转院日期后的中位数（四分位间距）56（27 - 134）天成功转院；95%的患者在转出后<18个月到达转院地点。在成功转院的患者中，留存比例在转院后1年至3年有所下降（从90%降至84%）。除了转院后3年时病毒载量<400拷贝/ml的情况外（86%对75%；P = 0.007），转院时与转院后1至3年期间，病毒载量<400拷贝/ml且CD4>500细胞/μl的留存青少年比例没有显著差异。15至19岁转院的青少年在转院后1年和2年时病毒学抑制且CD4>500细胞/μl的比例明显低于10至14岁转院的青少年。仅使用实验室数据会高估成功转院的时间。
将队列数据与卫生信息系统数据相链接能够有效评估转院后的结局。尽管超过80%的青少年成功转院，其中近85%在转院后留存3年，但病毒学抑制比例下降以及年龄较大青少年结局较差令人担忧。
