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多层面预测因素对南非农村综合慢性疾病管理模型中 CD4 计数和血压的控制效果:一项面板研究。

Multilevel predictors of controlled CD4 count and blood pressure in an integrated chronic disease management model in rural South Africa: a panel study.

机构信息

Department of Community Medicine, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria

Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.

出版信息

BMJ Open. 2020 Nov 3;10(11):e037580. doi: 10.1136/bmjopen-2020-037580.

Abstract

OBJECTIVE

In 2011, The National Department of Health introduced the Integrated Chronic Disease Management (ICDM) model as a pilot programme in selected primary healthcare facilities in South Africa. The objective of this study was to determine individual-level and facility-level predictors of controlled CD4 count and blood pressure (BP) in patients receiving treatment for HIV and hypertension, respectively.

DESIGN

A panel study.

SETTING AND PARTICIPANTS

This study was conducted in the Bushbuckridge Municipality, South Africa from 2011 to 2013. Facility records of patients aged ≥18 years were retrieved from the integrated chronic disease management (ICDM) pilot (n=435) and comparison facilities (n=443) using a three-step probability sampling process. CD4 count and BP control are defined as CD4 count >350 cells/mm and BP <140/90 mm Hg. A multilevel Least Absolute Shrinkage and Selection Operator binary logistic regression analysis was done at a 5% significance level using STATA V.16.

PRIMARY OUTCOME MEASURES

CD4 (cells/mm) count and BP (mm Hg).

RESULTS

Compared with the comparison facilities, patients receiving treatment in the pilot facilities had increased odds of controlling their CD4 count (OR=5.84, 95% CI 3.21-8.22) and BP (OR=1.22, 95% CI 1.04-2.14). Patients aged 50-59 (OR=6.12, 95% CI 2.14-7.21) and ≥60 (OR=7.59, 95% CI 4.75-11.82) years had increased odds of controlling their CD4 counts compared with those aged 18-29 years. Likewise, patients aged 40-49 (OR=5.73, 95% CI 1.98-8.43), 50-59 (OR=7.28, 95% CI 4.33-9.27) and ≥60 (OR=9.31, 95% CI 5.12-13.68) years had increased odds of controlling their BP. In contrast, men had decreased odds of controlling their CD4 count (OR=0.12, 95% CI 0.10-0.46) and BP (OR=0.21, 95% CI 0.19-0.47) than women.

CONCLUSION

The ICDM model had a small but significant effect on BP control, hence, the need to more effectively leverage the HIV programme for optimal BP control in the setting.

摘要

目的

2011 年,国家卫生部在南非选定的基层医疗机构推出综合慢性病管理(ICDM)模式作为试点项目。本研究旨在确定接受艾滋病毒和高血压治疗的患者的 CD4 计数和血压(BP)控制的个体和设施水平预测因素。

设计

面板研究。

地点和参与者

本研究于 2011 年至 2013 年在南非 Bushbuckridge 市进行。使用三步概率抽样过程从综合慢性病管理(ICDM)试点(n=435)和比较设施(n=443)中检索≥18 岁患者的设施记录。CD4 计数和 BP 控制定义为 CD4 计数>350 个细胞/mm3 和 BP<140/90mmHg。使用 STATA V.16 在 5%的显著水平上进行了最小绝对收缩和选择算子二元逻辑回归分析。

主要结局测量

CD4(细胞/mm3)计数和 BP(mmHg)。

结果

与比较设施相比,在试点设施接受治疗的患者控制 CD4 计数(OR=5.84,95%CI 3.21-8.22)和 BP(OR=1.22,95%CI 1.04-2.14)的可能性增加。与 18-29 岁的患者相比,50-59 岁(OR=6.12,95%CI 2.14-7.21)和≥60 岁(OR=7.59,95%CI 4.75-11.82)的患者控制 CD4 计数的可能性增加。同样,40-49 岁(OR=5.73,95%CI 1.98-8.43)、50-59 岁(OR=7.28,95%CI 4.33-9.27)和≥60 岁(OR=9.31,95%CI 5.12-13.68)的患者控制血压的可能性增加。相比之下,男性控制 CD4 计数(OR=0.12,95%CI 0.10-0.46)和 BP(OR=0.21,95%CI 0.19-0.47)的可能性低于女性。

结论

ICDM 模式对 BP 控制有较小但有意义的影响,因此需要更有效地利用艾滋病毒计划,以在该环境中实现最佳的 BP 控制。

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