Kouanfack Charles, Bede Fala, Nkfusai Claude Ngwayu, Wepngong Emerson, Venyuy Mbinkar Adeline, Hubert Chombong, Sam Denise Movuh, Cumber Samuel Nambile
Department of Public Health, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Cameroon.
Day Hospital, Hopital Central Yaounde, Cameroon.
Int J MCH AIDS. 2020;9(2):207-212. doi: 10.21106/ijma.305. Epub 2020 May 6.
After consecutively defaulting on their appointments for three months, many HIV positive patients are often reported to have defaulted on their treatment, become lost to follow-up (LTFU), or no longer in care. We sought to determine if retention in HIV/AIDS care and treatment is really poor.
Outcomes of patients with missed clinic appointments and reasons for missing appointments were studied. We sampled adult HIV positive patients on antiretroviral therapy (ART) who by clinic had missed their clinic appointments by more than four weeks between 1997 and 2019 at the HIV Care and Treatment Center (CTC) (Day Hospital) of the Yaoundé Central Hospital. We assumed that patients who missed their clinic appointment also missed some doses of their ART medications. Patients considered LTFU and those who had defaulted for two months were traced by telephone calls and home visits. Reasons for ART discontinuation were recorded for those who stopped or interrupted ART.
Of the 1139 patients who were either LTFU or who had defaulted for two months, 247/1139 (22 %) could not be traced. Out of the successfully traced patients, 50 (4%) had died and 798/1139 (70%) were alive and 310/1139 (27%) were on ART of which 35/1139 (3%) had developed informal ways of obtaining ART through clinic personnel. A good number were brought back to and reinitiated on ART after tracking (540/1139 or 47%). Of those known not to be on treatment(ART), 27/1139 (2%) had deliberately stopped ART and 63/1139 (6%) promised to return and took an appointment with CTC pyscho-social workers. Major reasons shared for missing clinic appointments were travel out of city (39%), distance from health facility, and financial cost for getting to health facility.
Despite clinic data showing many patients had missed monthly appointments or were LTFU, we saw that a sizeable amount of such patients were actually in care and on ART. The above findings lead to the suggestion that clinic data used in program performance evaluation may not always reflect the true picture retention in care for persons in HIV/AIDS programs at hospital and national levels.
据报告，许多艾滋病毒呈阳性的患者连续三个月未按预约就诊后，往往中断治疗、失访或不再接受治疗。我们试图确定艾滋病毒/艾滋病护理和治疗的留存率是否真的很低。
研究了错过门诊预约的患者的结局以及错过预约的原因。我们对雅温得中心医院艾滋病毒护理和治疗中心（日间医院）1997年至2019年间因门诊而错过门诊预约四周以上的接受抗逆转录病毒治疗（ART）的成年艾滋病毒阳性患者进行了抽样。我们假设错过门诊预约的患者也错过了一些剂量的ART药物。通过电话和家访追踪那些被视为失访以及那些已违约两个月的患者。记录了那些停止或中断ART治疗的患者停止治疗的原因。
在1139名失访或违约两个月的患者中，247/1139（22%）无法追踪到。在成功追踪到的患者中，50名（4%）已经死亡，798/1139（70%）还活着，310/1139（27%）正在接受ART治疗，其中35/1139（3%）通过诊所工作人员找到了获取ART的非正式途径。在追踪后，相当一部分患者被带回并重新开始接受ART治疗（540/1139或47%）。在那些已知未接受治疗（ART）的患者中，27/1139（2%）故意停止了ART治疗，63/1139（6%）承诺返回并与CTC心理社会工作者预约。错过门诊预约的主要原因是出城旅行（39%）、距离医疗机构较远以及前往医疗机构的经济成本。
尽管诊所数据显示许多患者错过了每月的预约或失访，但我们发现相当数量的此类患者实际上正在接受护理和ART治疗。上述发现表明，用于项目绩效评估的诊所数据可能并不总是反映医院和国家层面艾滋病毒/艾滋病项目中患者护理留存的真实情况。
