Elgalib Ali, Al-Sawafi Halima, Kamble Bina, Al-Harthy Saud, Al-Sariri Qamra
a Al-Nahdha Hospital , Muscat , Sultanate of Oman.
b Directorate General for Disease Surveillance and Control, Ministry of Health , Muscat , Sultanate of Oman.
AIDS Care. 2018 Sep;30(9):1114-1119. doi: 10.1080/09540121.2018.1479028. Epub 2018 May 24.
Multidisciplinary team (MDT) care models have been shown to improve clinical outcomes among HIV patients. We aim to assess the impact of adopting MDT approach in a tertiary HIV clinic in Muscat, Sultanate of Oman. We introduced MDT approach in our HIV centre in January 2016 where existing team members (counsellors, nurses, social workers, pharmacists and doctors) worked together, through care pathways, to support patients as they go through the HIV care continuum from diagnosis to viral suppression. Notes were reviewed for demographics and clinical data. The primary outcome was HIV viral load (VL) suppression (<20, < 200 and < 1000 copies/ml) in measurements by December 2015 and June 2017. In December 2015, 253 patients were in care; 98.4% (249/253) were on antiretroviral therapy (ART). Median age was 41 years and 70% were males. Median baseline CD4 was 204. In June 2017, 294 were in care with similar patient characteristics to those in care in 2015. The majority, 95.9% (282/294), were on ART; 8 of whom started ART within 3 months, hence excluded from the VL analysis. Overall, VL < 200 and < 1000 rates increased from 71.9% and 78.7% in 2015 to 90.5% and 95.6% in 2017, with relative risk (RR) (95% CI) of 1.26 (1.15-1.37) and 1.21 (1.13-1.30), respectively; p value < 0.0001 for both. In a sub-analysis of 214 patients who were in care in 2015 and remained in care in 2017, VL < 200 and < 1000 rates increased from 78.5% and 85% in 2015 to 90.2% and 94.4% in 2016, with RR (95% CI) of 1.15 (1.06 to 1.25) and 1.11 (1.04-1.18), respectively; p values of 0.0010 for both. MDT approach has significantly improved treatment outcome for existing patients and those who have attended our services since the introduction of the MDT model.
多学科团队（MDT）护理模式已被证明可改善HIV患者的临床结局。我们旨在评估在阿曼苏丹国马斯喀特的一家三级HIV诊所采用MDT方法的影响。2016年1月，我们在HIV中心引入了MDT方法，现有的团队成员（咨询师、护士、社会工作者、药剂师和医生）通过护理路径共同努力，在患者从诊断到病毒抑制的HIV护理连续过程中为其提供支持。对记录进行了人口统计学和临床数据审查。主要结局是2015年12月和2017年6月测量时的HIV病毒载量（VL）抑制（<20、<200和<1000拷贝/毫升）。2015年12月，有253名患者接受护理；98.4%（249/253）接受抗逆转录病毒治疗（ART）。中位年龄为41岁，70%为男性。基线CD4中位数为204。2017年6月，有294名患者接受护理，其患者特征与2015年接受护理的患者相似。其中大多数，95.9%（282/294）接受ART；其中8人在3个月内开始ART，因此被排除在VL分析之外。总体而言，VL<200和<1000的比例从2015年的71.9%和78.7%增加到2017年的90.5%和95.6%，相对风险（RR）（95%CI）分别为1.26（1.15 - 1.37）和1.21（1.13 - 1.30）；两者的p值均<0.0001。在对2015年接受护理且2017年仍在接受护理的214名患者的亚分析中，VL<200和<1000的比例从2015年的78.5%和85%增加到2016年的90.2%和94.4%，RR（95%CI）分别为1.15（1.06至1.25）和1.11（1.04 - 1.18）；两者的p值均为0.0010。MDT方法显著改善了现有患者以及自MDT模式引入以来接受我们服务的患者的治疗结局。
