INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé, Traitement de l'Information Médicale, Aix Marseille University, Marseille, France.
ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France.
J Acquir Immune Defic Syndr. 2019 Apr 1;80(4):375-385. doi: 10.1097/QAI.0000000000001938.
To study retention in care (RIC) trajectories and associated factors in patients eligible for antiretroviral therapy (ART) in a universal test-and-treat setting (TasP trial, South Africa, 2012-2016).
A cluster-randomized trial whereby individuals identified HIV positive after home-based testing were invited to initiate ART immediately (intervention) or following national guidelines (control).
Exiting care was defined as ≥3 months late for a clinic appointment, transferring elsewhere, or death. Group-based trajectory modeling was performed to estimate RIC trajectories over 18 months and associated factors in 777 ART-eligible patients.
Four RIC trajectory groups were identified: (1) group 1 "remained" in care (reference, n = 554, 71.3%), (2) group 2 exited care then "returned" after [median (interquartile range)] 4 (3-9) months (n = 40, 5.2%), (3) group 3 "exited care rapidly" [after 4 (4-6) months, n = 98, 12.6%], and (4) group 4 "exited care later" [after 11 (9-13) months, n = 85, 10.9%]. Group 2 patients were less likely to have initiated ART within 1 month and more likely to be male, young (<29 years), without a regular partner, and to have a CD4 count >350 cells/mm. Group 3 patients were more likely to be women without social support, newly diagnosed, young, and less likely to have initiated ART within 1 month. Group 4 patients were more likely to be newly diagnosed and aged 39 years or younger.
High CD4 counts at care initiation were not associated with a higher risk of exiting care. Prompt ART initiation and special support for young and newly diagnosed patients with HIV are needed to maximize RIC.
在普遍检测和治疗（TasP 试验，南非，2012-2016 年）的环境下，研究符合抗逆转录病毒治疗（ART）条件的患者的治疗保留（RIC）轨迹及其相关因素。
一项基于个体的随机试验，对家庭检测 HIV 阳性的个体，邀请其立即开始接受 ART（干预组）或遵循国家指南（对照组）。
失访定义为错过诊所预约时间≥3 个月、转至其他地方或死亡。对 777 名符合 ART 条件的患者进行了 18 个月的基于群组的轨迹建模，以估计 RIC 轨迹及其相关因素。
确定了 4 种 RIC 轨迹组：（1）“持续”留在治疗中的组 1（参考组，n=554，71.3%），（2）“失访后返回”的组 2[中位数（四分位距）]4（3-9）个月后（n=40，5.2%），（3）“快速失访”的组 3[4（4-6）个月后，n=98，12.6%]，和（4）“晚些时候失访”的组 4[11（9-13）个月后，n=85，10.9%]。组 2 患者更不可能在 1 个月内开始 ART，且更可能为男性、年轻（<29 岁）、无固定伴侣，以及 CD4 计数>350 个细胞/mm。组 3 患者更可能为没有社会支持、新诊断、年轻、且不太可能在 1 个月内开始 ART 的女性。组 4 患者更可能为新诊断和 39 岁或以下的患者。
高 CD4 计数与失访风险增加无关。需要尽快开始 ART，并为年轻和新诊断的 HIV 患者提供特殊支持，以最大限度地提高 RIC。
