Department of Epidemiology, Brown University, Box G-S121-2 121 South Main Street, Providence, Rhode Island, RI, 02903, USA.
Department of Environmental Health Engineering, Tufts University, Medford, MA, USA.
AIDS Behav. 2021 Oct;25(10):3337-3346. doi: 10.1007/s10461-021-03191-2. Epub 2021 Feb 20.
For people living with HIV (PLWH), patient transfers may affect engagement in care. We followed a cohort of PLWH in Cape Town, South Africa who tested positive for HIV in 2012-2013 from ART initiation in 2012-2016 through December 2016. Patient transfers were defined as moving from one healthcare facility to another on a different day, considering all healthcare visits and recorded HIV-visits only. We estimated incidence rates (IR) for transfers by time since ART initiation, overall and by gender, and associations between transfers and gaps of > 180 days in clinical care. Overall, 4,176 PLWH were followed for a median of 32 months, and 8% (HIV visits)-17% (all healthcare visits) of visits were patient transfers. Including all healthcare visits, transfers were highest through 3 months on ART (IR 20.2 transfers per 100 visits, 95% CI 19.2-21.2), but increased through 36 months on ART when only HIV visits were included (IR 9.7, 95% CI 8.8-10.8). Overall, women were more likely to transfer than men, and transfers were associated with gaps in care (IR ratio [IRR] 3.06 95% CI 2.83-3.32; HIV visits only). In this cohort, patient transfers were frequent, more common among women, and associated with gaps in care.
对于艾滋病毒感染者（PLWH），患者转院可能会影响他们接受治疗的情况。我们跟踪了 2012-2013 年在南非开普敦接受艾滋病毒检测呈阳性的 PLWH 队列，他们在 2012-2016 年期间开始接受抗逆转录病毒治疗，并在 2016 年 12 月之前进行了所有医疗访问和记录的艾滋病毒访问。患者转院是指在不同的日子从一家医疗机构转到另一家医疗机构，同时考虑所有的医疗访问和记录的艾滋病毒访问。我们根据开始接受抗逆转录病毒治疗后的时间，计算了转移的发生率（IR），包括所有转移和性别，以及转移与临床护理中超过 180 天的差距之间的关联。总体而言，4176 名 PLWH 被跟踪了中位数为 32 个月，8%（艾滋病毒访问）-17%（所有医疗访问）的访问是患者转院。包括所有医疗访问，转院在接受抗逆转录病毒治疗的前 3 个月最高（每 100 次访问中有 20.2 次转院，95%CI 19.2-21.2），但当仅包括艾滋病毒访问时，在接受抗逆转录病毒治疗的 36 个月时增加（IR 9.7，95%CI 8.8-10.8）。总体而言，女性比男性更有可能转院，而且转院与护理差距有关（IR 比值[IRR]3.06 95%CI 2.83-3.32；仅艾滋病毒访问）。在这个队列中，患者转院很常见，女性更为常见，并且与护理差距有关。
