Mshweshwe-Pakela Nolundi, Hansoti Bhakti, Mabuto Tonderai, Kerrigan Deanna, Kubeka Griffiths, Hahn Elizabeth, Charalambous Salome, Hoffmann Christopher J
Implementation Research Division, The Aurum Institute, Johannesburg, South Africa.
Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, United States of America.
South Afr J HIV Med. 2020 Aug 20;21(1):1085. doi: 10.4102/sajhivmed.v21i1.1085. eCollection 2020.
Same-day initiation (SDI) of antiretroviral therapy (ART) has been advocated as an approach to increase linkage to care and overall ART initiation. Clinical trials have demonstrated impressive benefits. However, questions regarding patient preparedness and retention in care remain for routine implementation of this approach.
In this study, we sought to describe SDI of ART during routine care delivery and compare time to ART initiation on longitudinal care outcomes.
We performed a retrospective chart review of 100 consecutive individuals, newly diagnosed with HIV, from 10 health facilities across Ekurhuleni, from January to July 2017. Records were reviewed for a period of 1 year post-diagnosis. Abstracted data included demographics, time to ART initiation, clinic visits and laboratory test results (including viral load testing).
A total of 993 patient records were reviewed, of which 826 were included in the analysis. The majority of patients (752, 91%) had ART initiation recorded, of which 654 (79%) had ART initiated within 30 days, and 224 (27%) had SDI. Uptake of SDI of ART was higher among women (36% vs. 10.4%; < 0.001) and in younger patients (33.7% in those < 29 years; < 0.01). Retention in care at 6 months was achieved in 477 (58%) patients. Of those with 6-month viral loads, 350/430 (73%) had a viral load < 400 c/m. Retention in care and viral suppression were similar among those with SDI of ART and later ART initiation.
Same-day initiation of ART was successfully delivered with similar retention and viral load outcomes as subsequent initiation, providing re-assurance for scale-up of this strategy in routine care.
抗逆转录病毒疗法（ART）同日启动（SDI）被倡导为一种增加治疗衔接和总体ART启动率的方法。临床试验已证明其有显著益处。然而，对于该方法在常规实施中患者的准备情况和治疗留存率仍存在疑问。
在本研究中，我们试图描述常规护理服务期间ART的SDI情况，并比较ART启动时间对纵向护理结果的影响。
我们对2017年1月至7月期间来自伊库鲁莱尼10家医疗机构的100例连续新诊断为HIV的个体进行了回顾性病历审查。对诊断后1年的记录进行审查。提取的数据包括人口统计学信息、ART启动时间、门诊就诊情况和实验室检查结果（包括病毒载量检测）。
共审查了993份患者记录，其中826份纳入分析。大多数患者（752例，91%）有ART启动记录，其中654例（79%）在30天内启动ART，224例（27%）为SDI。女性ART的SDI接受率更高（36%对10.4%；P<0.001），年轻患者中也是如此（29岁以下患者中为33.7%；P<0.01）。477例（58%）患者在6个月时实现了治疗留存。在有6个月病毒载量检测结果的患者中，350/430例（73%）病毒载量<400拷贝/毫升。ART的SDI患者和后期启动ART的患者在治疗留存率和病毒抑制方面相似。
ART同日启动在常规护理中成功实施，其留存率和病毒载量结果与后续启动相似，为在常规护理中扩大该策略提供了信心。
