Newlands Clinic, Harare, Zimbabwe.
Institute of Global Health, University of Geneva, Geneva, Switzerland.
PLoS One. 2020 Mar 2;15(3):e0228601. doi: 10.1371/journal.pone.0228601. eCollection 2020.
In 2015, Zimbabwe introduced third-line antiretroviral therapy (ART) through four designated treatment centers; three government clinics in Harare and Bulawayo, and Newlands Clinic (NC), operated by a private voluntary organization in Harare. We describe characteristics of patients receiving third line ART and analyzed treatment outcomes in this national programme as of 31 December 2018.
We described the population using proportions for categorical variables, and medians and interquartile ranges for continuous variables. Patients from NC, where data were more complete, were followed from the date of starting third-line ART until death, transfer, loss to follow up or 31 December 2018.
A total of 209 patients had ever received third-line ART: 124 at NC and 85 from the three government clinics. HIV genotype results were available for 89 (72%) patients at NC and fourteen (16.5%) patients in the government clinics. Median duration of third line ART (years) in the government clinics was 2.3 (IQR:0.6-3.4), 1.3 (IQR: 0.7-1.7) and 1 (0.6-1.9). Of the 67 patients who received third line ART in the government clinics for at least six months, 53 (79%) had most recent viral load (VL) < 1000 copies/ml. Data on other treatment outcomes from government clinics were incomplete. From NC: a total of 109 (88%) patients were still in care, 13 (10.5%) had died and 2 (1.5%) were transferred. Median duration of third-line ART was 1.4 years (IQR: 0.6-2.8). Among the 111 NC patients who had received third-line ART for at least 6 months, 83 (75%) had a VL <50 copies/ml and 106 (95.5%) had a VL <1000 copies/ml.
Our findings demonstrate that, with comprehensive care, patients failing second-line ART can achieve high rates of virological suppression on third-line regimens. There is need to decentralize the provision of third-line ART in Zimbabwe. More needs to be done to improve completeness of data in the government clinics.
2015 年，津巴布韦通过四个指定治疗中心（哈拉雷和布拉瓦约的三家政府诊所和由私人志愿组织运营的哈拉雷纽兰兹诊所）推出了三线抗逆转录病毒疗法（ART）。我们描述了接受三线 ART 治疗的患者的特征，并分析了截至 2018 年 12 月 31 日该国家方案的治疗结果。
我们使用比例描述了人口的分类变量，使用中位数和四分位距描述了连续变量。纽兰兹诊所的数据更为完整，从开始三线 ART 治疗之日起对那里的患者进行随访，直至死亡、转移、失访或 2018 年 12 月 31 日。
共有 209 名患者曾接受过三线 ART 治疗：124 名在纽兰兹诊所，85 名在三家政府诊所。纽兰兹诊所的 89 名（72%）患者和政府诊所的 14 名（16.5%）患者有 HIV 基因型检测结果。政府诊所的三线 ART 治疗中位持续时间（年）为 2.3（IQR：0.6-3.4）、1.3（IQR：0.7-1.7）和 1.0（0.6-1.9）。在政府诊所接受至少六个月三线 ART 治疗的 67 名患者中，53 名（79%）最近的病毒载量（VL）<1000 拷贝/ml。政府诊所其他治疗结果的数据不完整。纽兰兹诊所：共有 109 名（88%）患者仍在接受治疗，13 名（10.5%）患者死亡，2 名（1.5%）患者转移。三线 ART 治疗的中位持续时间为 1.4 年（IQR：0.6-2.8）。在纽兰兹诊所接受至少 6 个月三线 ART 治疗的 111 名患者中，83 名（75%）的 VL<50 拷贝/ml，106 名（95.5%）的 VL<1000 拷贝/ml。
我们的研究结果表明，在提供全面护理的情况下，二线 ART 失败的患者可以通过三线方案实现高病毒学抑制率。津巴布韦需要将三线 ART 的提供去中心化。还需要做更多的工作来提高政府诊所数据的完整性。
