Department of Health Services, Policy and Practice, Brown University, Providence, RI.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
J Acquir Immune Defic Syndr. 2018 Aug 1;78(4):383-389. doi: 10.1097/QAI.0000000000001703.
Home-based counseling and testing (HBCT) achieves earlier HIV diagnosis than other testing modalities; however, retention in care for these healthier patients is unknown. The objective of this study was to determine the association between point of HIV testing and retention in care and mortality.
Academic Model Providing Access to Healthcare (AMPATH) has provided HIV care in western Kenya since 2001.
AMPATH initiated HBCT in 2007. This retrospective analysis included individuals 13 years and older, enrolled in care between January 2008 and September 2016, with data on point of testing. Discrete-time multistate models were used to estimate the probability of transition between the following states: engaged, disengaged, transfer, and death, and the association between point of diagnosis and transition probabilities.
Among 77,358 patients, 67% women, median age: 35 years and median baseline CD4: 248 cells/mm. Adjusted results demonstrated that patients from HBCT were less likely to disengage [relative risk ratio (RRR) = 0.87, 95% CI: 0.83 to 0.91] and die (RRR = 0.65, 95% CI: 0.55 to 0.75), whereas those diagnosed through provider-initiated counseling and testing were more likely to disengage (RRR = 1.09, 95% CI: 1.07 to 1.12) and die (RRR = 1.13, 95% CI: 1.06 to 1.20), compared with patients from voluntary counseling and testing. Once disengaged, patients from HBCT were less likely to remain disengaged, compared with patients from voluntary counseling and testing.
Patients entering care from different HIV-testing programs demonstrate differences in retention in HIV care over time beyond disease severity. Additional research is needed to understand the patient and system level factors that may explain the associations between testing program, retention, and mortality.
家庭为基础的咨询和检测（HBCT）比其他检测方法更早地发现 HIV 感染；然而，对于这些健康状况较好的患者，他们是否能坚持接受治疗还不清楚。本研究的目的是确定 HIV 检测点与保留护理和死亡率之间的关联。
学术模型提供医疗保健（AMPATH）自 2001 年以来一直在肯尼亚西部提供 HIV 护理。
AMPATH 于 2007 年启动 HBCT。本回顾性分析纳入了 2008 年 1 月至 2016 年 9 月期间在 AMPATH 登记接受护理的年龄在 13 岁及以上的患者，并记录了检测点的数据。离散时间多状态模型用于估计以下状态之间的转移概率：参与、不参与、转移和死亡，并评估诊断点与转移概率之间的关系。
在 77358 名患者中，67%为女性，中位年龄为 35 岁，中位基线 CD4 细胞为 248 个/立方毫米。调整后的结果表明，HBCT 组患者的脱失率（相对危险比[RRR] = 0.87，95%置信区间[CI]：0.83 至 0.91）和死亡率（RRR = 0.65，95% CI：0.55 至 0.75）较低，而通过提供者发起的咨询和检测诊断的患者的脱失率（RRR = 1.09，95% CI：1.07 至 1.12）和死亡率（RRR = 1.13，95% CI：1.06 至 1.20）较高，与自愿咨询和检测的患者相比。一旦脱失，HBCT 组患者的脱失率低于自愿咨询和检测的患者。
来自不同 HIV 检测项目的患者在进入护理后，随着时间的推移，在 HIV 护理保留方面的差异超过了疾病严重程度。需要进一步研究以了解可能解释检测项目、保留和死亡率之间关系的患者和系统水平因素。
