Population Council, Washington, DC, United States of America.
Survey Warehouse, Windhoek, Namibia.
PLoS One. 2020 Dec 28;15(12):e0243749. doi: 10.1371/journal.pone.0243749. eCollection 2020.
This study aimed to help the Namibian government understand the impact of Treat All implementation (started on April 1, 2017) on key antiretroviral therapy (ART) outcomes, and how this transition impacts progress toward the UNAIDS's 90-90-90 HIV targets.
We collected clinical records from two separate cohorts (before and after treat-all) of ART patients in 10 high- and medium-volume facilities in 6 northern Namibia districts. Each cohort contains 12-month data on patients' scheduled appointments and visits, health status, and viral load results. We also measured patients' wait time and perceptions of service quality using exit interviews with 300 randomly selected patients (per round). We compared ART outcomes of the two cohorts: ART initiation within 7 days from diagnosis, loss to follow-up (LTFU), missed scheduled appointments for at least 30 days, and viral suppression using unadjusted and adjusted analyses.
Among new ART clients (on ART for less than 3 months or had not yet initiated treatment as of the start date for the ART record review period), rapid ART initiation (within 7 days from diagnosis) was 5.2 times higher after Treat All than that among clients assessed before the policy took effect [AOR: 5.2 (3.8-6.9)]. However, LTFU was higher after Treat All roll-out compared to before Treat All [AOR: 1.9 (1.3-2.8)]. Established ART clients (on ART treatment for at least three months at the start date of the ART record review period) had over 3 times greater odds of achieving viral suppression after Treat All roll-out compared to established ART clients assessed before Treat All [AOR: 3.1 (1.6-5.9)].
The findings indicate positive effect of the "Treat All" implementation on ART initiation and viral suppression, and negative effect on LTFU. Additionally, by April 2018, Namibia seems to have reached the UNAIDS's 90-90-90 targets.
本研究旨在帮助纳米比亚政府了解 2017 年 4 月 1 日开始实施的“全面治疗”（Treat All）对关键抗逆转录病毒治疗（ART）结果的影响，以及这一转变如何影响实现艾滋病规划署 90-90-90 艾滋病毒目标的进展。
我们从纳米比亚北部 6 个地区的 10 个高容量和中容量设施的两个单独队列（治疗前和治疗后）中收集了临床记录。每个队列包含 12 个月的患者预约和就诊、健康状况和病毒载量结果数据。我们还通过对 300 名随机选择的患者（每轮）进行退出访谈，测量了患者的等待时间和对服务质量的看法。我们使用未调整和调整后的分析比较了两个队列的 ART 结果：从诊断之日起 7 天内开始接受 ART 治疗、失访（LTFU）、至少 30 天未按计划预约和病毒抑制。
在新的 ART 患者（开始 ART 治疗不到 3 个月或在开始评估 ART 记录审查期间尚未开始治疗）中，与政策生效前评估的患者相比，Treat All 后快速开始 ART 的比例（从诊断之日起 7 天内）高 5.2 倍[调整后的比值比（AOR）：5.2（3.8-6.9）]。然而，与 Treat All 推出前相比，Treat All 推出后 LTFU 更高[AOR：1.9（1.3-2.8）]。在开始 ART 记录审查期间至少已接受 3 个月 ART 治疗的现有 ART 患者，与在 Treat All 前评估的现有 ART 患者相比，实现病毒抑制的几率高 3 倍以上[AOR：3.1（1.6-5.9）]。
研究结果表明，“全面治疗”的实施对开始接受 ART 治疗和病毒抑制产生了积极影响，对失访产生了消极影响。此外，到 2018 年 4 月，纳米比亚似乎已经实现了艾滋病规划署的 90-90-90 目标。
