乌干达农村地区错过就诊后重新参与艾滋病护理。
Re-engagement in HIV care following a missed visit in rural Uganda.
作者信息
Nabaggala Maria Sarah, Parkes-Ratanshi Rosalind, Kasirye Ronnie, Kiragga Agnes, Castlenuovo Barbara, Ochaka Ian, Nakakawa Lilian, Bena Diana Asiimwe, Mujugira Andrew
机构信息
Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK.
出版信息
BMC Res Notes. 2018 Oct 25;11(1):762. doi: 10.1186/s13104-018-3865-9.
OBJECTIVE
We conducted a retrospective cohort study to assess the effect of tracking People Living with HIV (PLHIV) after missed clinic visits and factors associated with return to care in rural Uganda. We assessed retention in care among 650 HIV-infected women and men. We used univariable and multivariable generalized linear models to assess demographic and self-reported factors associated with re-engagement in HIV care.
RESULTS
Of 381 PLHIV who ever missed a scheduled appointment, 68% were female and most (80%) had initiated ART. Most (70%) of those tracked returned to care. Relative to men, women (adjusted risk ratio [ARR] 1.23; 95% confidence interval (CI) 1.05-1.43; p = 0.009) were more likely to return to care after active tracking. PLHIV who missed scheduled visits for other reasons (forgetting, adequate drug supplies, or long distance to clinic) had reduced odds of return to care (ARR 0.41; 95% CI 0.28-0.59; p < 0.001). These data support close monitoring of patient retention in HIV care and active measures to re-engage those who miss an appointment. Furthermore, they highlight the need for targeted interventions to those more resistant to re-engagement such as men.
目的
我们开展了一项回顾性队列研究，以评估在乌干达农村地区对错过门诊就诊的艾滋病毒感染者（PLHIV）进行追踪的效果以及与重新接受治疗相关的因素。我们评估了650名感染艾滋病毒的女性和男性的治疗留存率。我们使用单变量和多变量广义线性模型来评估与重新参与艾滋病毒治疗相关的人口统计学因素和自我报告因素。
结果
在381名曾错过预约就诊的PLHIV中，68%为女性，且大多数（80%）已开始接受抗逆转录病毒治疗（ART）。大多数（70%）被追踪的人重新接受了治疗。与男性相比，女性在积极追踪后更有可能重新接受治疗（调整风险比[ARR]为1.23；95%置信区间[CI]为1.05 - 1.43；p = 0.009）。因其他原因（忘记、药品供应充足或距离诊所较远）错过预约就诊的PLHIV重新接受治疗的几率降低（ARR为0.41；95% CI为0.28 - 0.59；p < 0.001）。这些数据支持密切监测艾滋病毒治疗中的患者留存情况，并采取积极措施让错过预约的患者重新接受治疗。此外，它们凸显了针对那些更难重新参与治疗的人群（如男性）进行有针对性干预的必要性。
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