MRC/UVRI & LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, P. O Box 49, Entebbe, Uganda.
London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
BMC Public Health. 2020 Mar 18;20(1):353. doi: 10.1186/s12889-020-8439-9.
Immediate uptake of antiretroviral therapy (ART) after an HIV-positive diagnosis (Test and Treat) is now being implemented in Uganda. Data are limited on lost to follow-up (LTFU) in high-risk cohorts that have initiated 'Test and Treat'. We describe LTFU in a cohort of women of high-risk sexual behaviour who initiated ART under "Test and Treat".
We performed a retrospective cohort study of participant records at the Good Health for Women Project (GHWP) clinic, a clinic in Kampala for women at high-risk of HIV-infection. We included HIV positive women ≥18 years who initiated ART at GHWP between August 2014 and March 2018. We defined LTFU as not taking an ART refill for ≥3 months from the last clinic appointment among those not registered as dead or transferred to another clinic. We used the Kaplan-Meier technique to estimate time to LTFU after ART initiation. Predictors of LTFU were assessed using a multivariable Cox proportional hazards model.
The mean (±SD) age of the 293 study participants was 30.3 (± 6.5) years, with 274 (94%) reporting paid sex while 38 (13%) had never tested for HIV before enrolment into GHWP. LTFU within the first year of ART initiation was 16% and the incidence of LTFU was estimated at 12.7 per 100 person-years (95%CI 9.90-16.3). In multivariable analysis, participants who reported sex work as their main job at ART initiation (Adjusted Hazards Ratio [aHR] =1.95, 95%CI 1.10-3.45), having baseline WHO clinical stage III or IV (aHR = 2.75, 95% CI 1.30-5.79) were more likely to be LTFU.
LTFU in this cohort is high. Follow up strategies are required to support women on Test and Treat to remain on treatment, especially those who engage in sex work and those who initiate ART at a later stage of disease.
在乌干达，艾滋病毒阳性诊断后立即开始接受抗逆转录病毒治疗（Test and Treat）目前正在实施。关于已经开始“Test and Treat”的高危人群中失访（LTFU）的数据有限。我们描述了在一个高风险性行为的女性队列中，在“Test and Treat”下开始接受抗逆转录病毒治疗（ART）的患者中失访的情况。
我们对 Good Health for Women Project（GHWP）诊所的参与者记录进行了回顾性队列研究，该诊所是坎帕拉一家为感染艾滋病毒风险较高的女性提供服务的诊所。我们纳入了 2014 年 8 月至 2018 年 3 月期间在 GHWP 开始接受 ART 的年龄≥18 岁的 HIV 阳性女性。我们将最后一次就诊后≥3 个月未取 ART 药的定义为失访，除非已登记死亡或转至其他诊所。我们使用 Kaplan-Meier 技术估计 ART 起始后失访的时间。使用多变量 Cox 比例风险模型评估失访的预测因素。
293 名研究参与者的平均（±SD）年龄为 30.3（±6.5）岁，其中 274 名（94%）报告有有偿性工作，而 38 名（13%）在入组 GHWP 前从未检测过 HIV。ART 起始后 1 年内的失访率为 16%，失访率估计为每 100 人年 12.7 例（95%CI 9.90-16.3）。在多变量分析中，以性工作为主要职业的参与者在开始 ART 时（调整后的危险比[aHR]=1.95，95%CI 1.10-3.45）、基线 WHO 临床分期为 III 或 IV 期（aHR=2.75，95%CI 1.30-5.79）的参与者更有可能失访。
在这个队列中，失访率很高。需要采取随访策略来支持接受 Test and Treat 的女性继续治疗，尤其是那些从事性工作和在疾病晚期开始接受 ART 的女性。
