Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.
Research Division, Rwanda Military Hospital, Kigali, Rwanda.
J Int AIDS Soc. 2019 Apr;22(4):e25279. doi: 10.1002/jia2.25279.
INTRODUCTION: Nearly all countries in sub-Saharan Africa have adopted policies to provide antiretroviral therapy (ART) to all persons living with HIV (Treat All), though HIV care outcomes of these programmes are not well-described. We estimated changes in ART initiation and retention in care following Treat All implementation in Rwanda in July 2016. METHODS: We conducted an interrupted time series analysis of adults enrolling in HIV care at ten Rwandan health centres from July 2014 to September 2017. Using segmented linear regression, we assessed changes in levels and trends of 30-day ART initiation and six-month retention in care before and after Treat All implementation. We compared modelled outcomes with counterfactual estimates calculated by extrapolating baseline trends. Modified Poisson regression models identified predictors of outcomes among patients enrolling after Treat All implementation. RESULTS: Among 2885 patients, 1803 (62.5%) enrolled in care before and 1082 (37.5%) after Treat All implementation. Immediately after Treat All implementation, there was a 31.3 percentage point increase in the predicted probability of 30-day ART initiation (95% CI 15.5, 47.2), with a subsequent increase of 1.1 percentage points per month (95% CI 0.1, 2.1). At the end of the study period, 30-day ART initiation was 47.8 percentage points (95% CI 8.1, 87.8) above what would have been expected under the pre-Treat All trend. For six-month retention, neither the immediate change nor monthly trend after Treat All were statistically significant. While 30-day ART initiation and six-month retention were less likely among patients 15 to 24 versus >24 years, the predicted probability of both outcomes increased significantly for younger patients in each month after Treat All implementation. CONCLUSIONS: Implementation of Treat All in Rwanda was associated with a substantial increase in timely ART initiation without negatively impacting care retention. These early findings support Treat All as a strategy to help achieve global HIV targets.
引言：几乎所有撒哈拉以南非洲国家都采取了向所有艾滋病毒感染者（Treat All）提供抗逆转录病毒治疗（ART）的政策，尽管这些方案的艾滋病毒护理结果并未得到很好的描述。我们评估了 2016 年 7 月在卢旺达实施“全面治疗”后，ART 启动和维持治疗的变化。 方法：我们对 2014 年 7 月至 2017 年 9 月在卢旺达 10 个卫生中心接受艾滋病毒护理的成年人进行了一项中断时间序列分析。使用分段线性回归，我们评估了在实施“全面治疗”之前和之后，30 天内开始接受 ART 治疗和 6 个月内保持护理的水平和趋势的变化。我们将模型结果与通过外推基线趋势计算的反事实估计进行了比较。改良泊松回归模型确定了在“全面治疗”实施后登记的患者结局的预测因素。 结果：在 2885 名患者中，1803 名（62.5%）在“全面治疗”前登记，1082 名（37.5%）在“全面治疗”后登记。在“全面治疗”实施后，30 天内开始接受 ART 治疗的预测概率立即增加了 31.3 个百分点（95%可信区间 15.5%，47.2%），随后每月增加 1.1 个百分点（95%可信区间 0.1%，2.1%）。在研究结束时，30 天内开始接受 ART 治疗的比例比“全面治疗”前趋势高出 47.8 个百分点（95%可信区间 8.1%，87.8%）。对于 6 个月的保留率，“全面治疗”后立即发生的变化和每月趋势均无统计学意义。虽然 15 至 24 岁与 >24 岁的患者接受 30 天内开始接受 ART 治疗和 6 个月内保留治疗的可能性较低，但在“全面治疗”后每个月，年轻患者的这两种结局的预测概率都显著增加。 结论：卢旺达实施“全面治疗”与及时开始接受 ART 治疗的大幅增加有关，而不会对保留护理产生负面影响。这些早期发现支持“全面治疗”作为实现全球艾滋病毒目标的一种策略。
Trop Med Int Health. 2018-7-26
J Acquir Immune Defic Syndr. 2018-4-15
Zotero 插件