一项针对卫生部门数据到护理干预措施的集群随机评估，旨在提高艾滋病毒护理和抗逆转录病毒使用的参与度。
A Cluster Randomized Evaluation of a Health Department Data to Care Intervention Designed to Increase Engagement in HIV Care and Antiretroviral Use.
机构信息
Biostatistics, University of Washington, Seattle, WA.
Public Health-Seattle & King County HIV/STD Program.
出版信息
Sex Transm Dis. 2018 Jun;45(6):361-367. doi: 10.1097/OLQ.0000000000000760.
BACKGROUND
Many US health departments have implemented Data to Care interventions, which use HIV surveillance data to identify persons who are inadequately engaged in HIV medical care and assist them with care reengagement, but the effectiveness of this strategy is uncertain.
METHODS
We conducted a stepped-wedge, cluster-randomized evaluation of a Data to Care intervention in King County, Washington, 2011 to 2014. Persons diagnosed as having HIV for at least 6 months were eligible based on 1 of 2 criteria: (1) viral load (VL) greater than 500 copies/mL and CD4 less than 350 cells/μL at the last report in the past 12 months or (2) no CD4 or VL reported to the health department for at least 12 months. The intervention included medical provider contact, patient contact, and a structured individual interview. Health department staff assisted patients with reengagement using health systems navigation, brief counseling, and referral to support services. We clustered all eligible cases in the county by the last known medical provider and randomized the order of clusters for intervention, creating contemporaneous intervention and control periods (cases in later clusters contributed person-time to the control period at the same time that cases in earlier clusters contributed person-time to the intervention period). We compared the time to viral suppression (VL <200 copies/mL) for individuals during intervention and control periods using a Cox proportional hazards model.
RESULTS
We identified 997 persons (intention to treat [ITT]), 18% of whom had moved or died. Of the remaining 822 (modified ITT), 161 (20%) had an undetectable VL reported before contact and 164 (20%) completed the individual interview. The hazard ratio (HR) for time to viral suppression did not differ between the intervention and control periods in ITT (HR, 1.21 [95% confidence interval, 0.85-1.71]) or modified ITT (HR, 1.18 [95% confidence interval, 0.83-1.68]) analysis.
CONCLUSIONS
The Data to Care intervention did not impact time to viral suppression.
背景
许多美国卫生部门已经实施了 Data to Care 干预措施，这些措施利用 HIV 监测数据来识别那些未充分参与 HIV 医疗护理的人群，并协助他们重新参与护理，但这种策略的有效性尚不确定。
方法
我们在华盛顿州金县进行了一项 Data to Care 干预的分步楔形、聚类随机评估，时间为 2011 年至 2014 年。符合以下标准之一的至少确诊 HIV 6 个月的人群有资格参与研究：（1）过去 12 个月内最后一次报告的病毒载量（VL）大于 500 拷贝/毫升且 CD4 细胞计数小于 350 个/μL，或（2）至少 12 个月未向卫生部门报告 CD4 或 VL。该干预措施包括医疗服务提供者联系、患者联系和结构化个体访谈。卫生部门工作人员通过健康系统导航、简短咨询和向支持服务机构转介，协助患者重新参与护理。我们按县内最后已知的医疗服务提供者对所有符合条件的病例进行聚类，并随机化聚类的干预顺序，创建同期干预和对照期（较晚聚类中的病例同时为对照期贡献了人员时间，而较早聚类中的病例则为干预期贡献了人员时间）。我们使用 Cox 比例风险模型比较个体在干预期和对照期的病毒抑制时间（VL <200 拷贝/毫升）。
结果
我们确定了 997 名患者（意向治疗[ITT]），其中 18%的患者已经搬离或死亡。在其余的 822 名（改良 ITT）患者中，有 161 名（20%）在接触前报告了无法检测到的 VL，有 164 名（20%）完成了个体访谈。在 ITT（危险比[HR]，1.21[95%置信区间，0.85-1.71]）或改良 ITT（HR，1.18[95%置信区间，0.83-1.68]）分析中，干预期和对照期的病毒抑制时间的 HR 没有差异。
结论
Data to Care 干预措施并未影响病毒抑制时间。
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