Division of Infectious Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
Partners in Hope, Lilongwe, Malawi.
AIDS. 2020 Mar 1;34(3):475-479. doi: 10.1097/QAD.0000000000002435.
Little is known about the proportion of HIV-positive clients on antiretroviral therapy (ART) who meet stability criteria for differentiated service delivery (DSD) models. We report the proportion of ART clients meeting stability criteria as part of screening for a randomized trial of multimonth dispensing in Malawi and Zambia.
For a DSD trial now underway, we screened HIV-positive clients aged at least 18 years presenting for HIV treatment in 30 adult ART clinics in Malawi and Zambia to determine eligibility for DSD. Stability was defined as on first-line ART (efavirenz/tenofovir/lamivudine) for at least 6 months, no ART side effects, no toxicity or infectious complications, no noncommunicable diseases being treated in ART clinic, no lapses in ART adherence in the prior 6 months (>30 days without taking ART), and if female, not pregnant or breastfeeding.
In total, 3465 adult ART clients were approached between 10 May 2017 and 30 April 2018 (Malawi: 1680; Zambia: 1785). Of the 2938 who answered screening questions (Malawi: 1527; Zambia: 1411), 2173 (73.5%) met criteria for DSD eligibility (Malawi: 72.8%; Zambia: 74.3%). The most common reasons for ineligibility were being on ART less than 6 months (9.6%) and a regimen other than standard first-line (7.9%).
Approximately three-quarters of all adult clients presenting at ART clinics in Malawi and Zambia were eligible for DSD using a typical definition of stability. High uptake of DSD models by eligible clients would have a major impact on the infrastructure and the allocation of HIV treatment resources.
目前对于符合差异化服务提供（DSD）模型稳定性标准的接受抗逆转录病毒治疗（ART）的艾滋病毒阳性患者的比例知之甚少。我们报告了在马拉维和赞比亚正在进行的一项多剂量药物分发随机试验的筛查中，符合稳定性标准的 ART 患者比例。
为了进行一项正在进行的 DSD 试验，我们筛选了在马拉维和赞比亚的 30 个成人 ART 诊所就诊的至少 18 岁的 HIV 阳性患者，以确定他们是否符合 DSD 的条件。稳定性定义为至少 6 个月的一线 ART（依非韦伦/替诺福韦/拉米夫定）、没有 ART 副作用、没有毒性或感染并发症、在 ART 诊所中没有治疗非传染性疾病、在过去 6 个月中没有 ART 依从性中断（超过 30 天没有服用 ART），如果是女性，则没有怀孕或哺乳期。
共有 3465 名成年 ART 患者在 2017 年 5 月 10 日至 2018 年 4 月 30 日之间接受了接触（马拉维：1680；赞比亚：1785）。在回答筛查问题的 2938 人中（马拉维：1527；赞比亚：1411），有 2173 人（73.5%）符合 DSD 资格标准（马拉维：72.8%；赞比亚：74.3%）。不符合条件的最常见原因是接受 ART 不到 6 个月（9.6%）和非标准一线治疗方案（7.9%）。
在马拉维和赞比亚的所有成人 ART 诊所就诊的患者中，大约有四分之三符合使用典型稳定性定义的 DSD 资格。符合条件的患者对 DSD 模型的高接受率将对基础设施和 HIV 治疗资源的分配产生重大影响。
