Bucciardini Raffaella, Fragola Vincenzo, Abegaz Teshome, Lucattini Stefano, Halifom Atakilt, Tadesse Eskedar, Berhe Micheal, Pugliese Katherina, Fucili Luca, Gregorio Massimiliano Di, Mirra Marco, Castro Paola De, Terlizzi Roberta, Tatarelli Paola, Binelli Andrea, Zegeye Teame, Campagnoli Michela, Vella Stefano, Abraham Loko, Godefay Hagos
Istituto Superiore di Sanità, Rome, Italy.
College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
BMJ Glob Health. 2017 Aug 6;2(3):e000325. doi: 10.1136/bmjgh-2017-000325. eCollection 2017.
Ethiopia has experienced rapid expansion of antiretroviral therapy (ART). However, as long-term retention in ART therapy is key for ART effectiveness, determinants of attrition need to be identified so appropriate interventions can be designed.
We used data from the 'Cohort of African people Starting Antiretroviral therapy' (CASA) project, a prospective study of a cohort of HIV-infected patients who started ART in seven health facilities (HFs). We analysed the data of patients who had started first-line ART between January 2013 and December 2014. The Kaplan-Meier method was used to estimate the probability of retention at different time points. The Cox proportional hazards model was used to identify factors associated with attrition.
A total of 1198 patients were included in the study. Kaplan-Meier estimates of retention in care were 83.9%, 82.1% and 79.8% at 12, 18 and 24 months after starting ART, respectively. Attrition was mainly due to loss to follow-up, transferred-out patients and documented mortality. A multivariate Cox proportional hazard model showed that male sex, CD4 count <200 cells/µL and the type of HF were significantly associated with attrition.
The observed attrition differences according to gender suggest that separate interventions designed for women and men should be explored. Moreover, innovative strategies to increase HIV testing should be supported to avoid CD4 levels falling too low, a factor significantly associated with higher attrition in our study. Finally, specific studies to analyse the reasons for different levels of attrition among HFs are required.
埃塞俄比亚的抗逆转录病毒疗法（ART）迅速扩展。然而，由于长期坚持ART治疗是ART有效性的关键，因此需要确定治疗中断的决定因素，以便设计适当的干预措施。
我们使用了“非洲人开始抗逆转录病毒治疗队列”（CASA）项目的数据，这是一项对在七个医疗机构开始接受ART治疗的HIV感染患者队列进行的前瞻性研究。我们分析了2013年1月至2014年12月期间开始接受一线ART治疗的患者数据。采用Kaplan-Meier方法估计不同时间点的留存概率。使用Cox比例风险模型确定与治疗中断相关的因素。
共有1198名患者纳入研究。开始ART治疗后12、18和24个月的护理留存率的Kaplan-Meier估计值分别为83.9%、82.1%和79.8%。治疗中断主要是由于失访、转出患者和记录在案的死亡。多变量Cox比例风险模型显示，男性、CD4细胞计数<200个/微升和医疗机构类型与治疗中断显著相关。
观察到的按性别划分的治疗中断差异表明，应探索为女性和男性设计的单独干预措施。此外，应支持增加HIV检测的创新策略，以避免CD4水平降得过低，这是我们研究中与较高治疗中断显著相关的一个因素。最后，需要进行具体研究以分析不同医疗机构中不同治疗中断水平的原因。
