Lertpiriyasuwat Cheewanan, Teeraratkul Achara, Suchonwanich Yolsilp, Chatharojwong Nartlada, Phokasawad Kunjanakorn, Yuktanon Porntip, Pattarapayoon Naparat, Bhakeecheep Sorakij, Bertagnolio Silvia, Roels Thierry H, Thanprasertsuk Sombat
Bureau of AIDS, TB and STIs, Department of Disease Control, Thailand Ministry of Public Health, Nonthaburi, Thailand.
Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Division of Global HIV/AIDS and TB, Thailand/Asia Regional Office, Thailand.
J Med Assoc Thai. 2017 Sep;100(9):944-952.
To describe trends in Thailand's antiretroviral treatment (ART) program performance assessed by HIV drug resistance early warning indicators (EWIs), as recommended by WHO, between 2009 and 2013.
Seven EWIs were monitored, viral load (VL) testing coverage, VL suppression, retention in ART, lost to follow-up (LTFU), antiretrovirals (ARVs) dispensing practices, on-time pill pick-up, and pharmacy stock-outs. Data from ART adult patients in National Health Security Office Scheme were analyzed except for pharmacy stock-outs, which were reported from hospitals. Aggregated averages were calculated for each EWI. Chi-square for trend was applied to measure significant changes.
By September 2013, 174,284 adults were receiving ART at 929 hospitals. Over time, improvement in VL testing coverage (53.8% in 2009 to 79.8% in 2013) was observed. VL suppression and on-time pill pick up rates were well above 90%. Rates of retention in ART declined from 84.0 to 82.9%, whereas LTFU rates increased from 8.3 to 9.2% (p<0.001). Prescriptions with inappropriate ARVs decreased from 0.32 to 0.10% (p<0.001). Of reporting hospitals, 96.1%, 96.3%, and 96.2% observed no ARVs stock-out between 2011 and 2013.
EWI is a useful tool to monitor ART program performance and to identify area where improvement is needed.
按照世界卫生组织的建议，描述2009年至2013年间泰国通过艾滋病毒耐药性早期预警指标（EWIs）评估的抗逆转录病毒治疗（ART）项目的执行趋势。
监测了七个早期预警指标，即病毒载量（VL）检测覆盖率、VL抑制率、ART治疗留存率、失访（LTFU）率、抗逆转录病毒药物（ARVs）发放情况、按时取药情况以及药房药品缺货情况。分析了国家卫生安全办公室计划中ART成年患者的数据，但药房药品缺货情况数据来自医院报告。计算每个早期预警指标的汇总平均值。应用趋势卡方检验来衡量显著变化。
截至2013年9月，929家医院的174,284名成年人正在接受ART治疗。随着时间推移，观察到VL检测覆盖率有所提高（从2009年的53.8%提高到2013年的79.8%）。VL抑制率和按时取药率均远高于90%。ART治疗留存率从84.0%降至82.9%，而失访率从8.3%升至9.2%（p<0.001）。使用不适当ARVs的处方从0.32%降至0.10%（p<0.001）。在报告的医院中，96.1%、96.3%和96.2%在2011年至2013年间未出现ARVs缺货情况。
早期预警指标是监测ART项目执行情况以及识别需要改进领域的有用工具。
