Department of Public Health Sciences/Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden.
Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
J Int AIDS Soc. 2018 Nov;21(11):e25196. doi: 10.1002/jia2.25196.
When measuring the success of HIV programmes to retain patients in care, few studies distinguish between retention in clinic (individual returns to the same clinic) and retention in care (individual is active in care at initial site or elsewhere). The objectives of this study were to quantify retention in clinic versus retention in care and determine risk factors associated with attrition from care in low-income settings in Nairobi, Kenya.
Between April 2013 and June 2015, adults testing positive for HIV were recruited at two comprehensive care clinics in informal urban settlements. Participants were followed from the time of a positive HIV test for up to 14 months. Participants who did not return to the clinic for their 12-month appointment between 10 and 14 months after their baseline visit were traced by telephone or community outreach to determine whether they were still receiving HIV care. We used generalized linear regression to determine the association between clinical and socio-demographic factors and attrition from care at 12 months.
Of the 1068 individuals screened for study participation, 775 individuals newly presenting to HIV care were included in this study. Between 10 and 14 months, 486 participants (62.7%, 95% confidence intervals [CI], 59.2% to 66.1%) returned to the clinic for their 12-month appointment (retained in clinic). After telephone tracing and community outreach, an additional 123 of 289 participants were found to be active in care at other HIV clinics (42.6%, 95% CI, 36.8% to 48.5%). Overall, 609 (78.6%, 95% CI, 75.7% to 81.5%) participants were retained in care at any HIV clinic at 12 months. Participants in higher baseline CD4 count categories were more likely to be retained than those whose baseline CD4 count was <200 cells/mm .
Retention in clinic substantially underestimated retention in care 12 months after presenting to care in this high-prevalence and low-income urban setting. Improved systems to track patients between clinics are required to accurately estimate retention in care in resource-limited settings. Although the proportion of patients retained in care was greater than expected, interventions to improve retention in care are needed to meet global targets to end the AIDS epidemic.
在衡量艾滋病毒项目将患者保留在治疗中的成功时，很少有研究将在诊所的保留（个人返回同一诊所）和在治疗中的保留（个人在初始地点或其他地方积极接受治疗）区分开来。本研究的目的是量化在诊所的保留与在治疗中的保留，并确定在肯尼亚内罗毕低收入环境中与治疗中断相关的风险因素。
2013 年 4 月至 2015 年 6 月，在两个非正式城市住区的综合护理诊所招募了 HIV 检测呈阳性的成年人。从 HIV 检测阳性开始，参与者最多可随访 14 个月。在基线检查后 10 至 14 个月之间，没有返回诊所进行 12 个月预约的参与者通过电话或社区外展进行追踪，以确定他们是否仍在接受艾滋病毒治疗。我们使用广义线性回归来确定临床和社会人口统计学因素与 12 个月时的治疗中断之间的关联。
在接受研究参与筛选的 1068 人中，有 775 名新出现的艾滋病毒感染者被纳入本研究。在 10 至 14 个月期间，486 名参与者（62.7%，95%置信区间[CI]，59.2%至 66.1%）返回诊所进行 12 个月预约（在诊所保留）。在电话追踪和社区外展后，另外 289 名参与者中的 123 名被发现正在其他艾滋病毒诊所接受治疗（42.6%，95%CI，36.8%至 48.5%）。总体而言，609 名参与者（78.6%，95%CI，75.7%至 81.5%）在 12 个月时在任何艾滋病毒诊所保留治疗。基线时 CD4 计数较高的参与者比基线时 CD4 计数<200 个细胞/mm3的参与者更有可能保留在治疗中。
在这个高患病率和低收入的城市环境中，在就诊后 12 个月时，在诊所的保留大大低估了在治疗中的保留。需要改进在诊所之间跟踪患者的系统，以准确估计资源有限环境中的保留率。尽管保留在治疗中的患者比例高于预期，但仍需要采取干预措施来提高保留率，以实现终结艾滋病流行的全球目标。
