Mbarara University of Science and Technology, P.O Box 1410, Mbarara, Uganda.
Immunosuppression Clinic Mbarara Regional Referral Hospital, Mbarara, Uganda.
AIDS Res Ther. 2021 Mar 20;18(1):7. doi: 10.1186/s12981-021-00331-5.
BACKGROUND: Good adherence to antiretroviral therapy (ART) and retention in care are essential for the effectiveness of an HIV care program. With the current increase in numbers of people living with HIV taking second-line ART in sub-Saharan Africa, there is a need to establish their treatment outcomes and the rate of loss to follow up. In this study, we determined the incidence and predictors of loss to follow up among patients taking second-line ART at an experienced HIV treatment center in southwestern Uganda. METHODS: This was a retrospective review of an electronic database at Mbarara Regional Referral Hospital HIV clinic in southwestern Uganda. Second-line ART included at least two of the nucleoside reverse transcriptase inhibitors and a boosted protease inhibitor. Loss to follow-up was defined as failure to return to the health facility for care or treatment refill for 180 days or more from the previous visit. After excluding children less than 15 years, we pooled data that included socio-demographic, clinical, and laboratory data for patients who started second-line ART between 2002 and 2017. Multiple imputation was done for variables with missing data. Variables that had a p < 0.05 in unadjusted bivariate analyses were included in a multivariate binomial regression model using a stepwise backward selection procedure to describe the factors that independently predicted loss to follow-up. RESULTS: Between 2002 and 2017, 1121 patients had been initiated on second-line ART. We included data from 924 participants and of these, 518 (56.1%) were female, the mean age (SD) was 38.4 (± 10.5) years, and 433 (52.4%) had a CD4 count less than 100 cells/µl at the start of second-line ART. The incidence of loss to follow-up was 26.7 per 100 person-years. Male gender (Adjusted risk ratio (ARR) = 1.8, 95% CI 1.5-2.0) p < 0.001 and anemia ARR 1.4, 95% CI 1.1-1.6) p < 0.001 were strongly associated with loss to follow up. CONCLUSIONS: There is a high incidence of loss to follow up among patients taking protease-inhibitor based second-line ART at a tertiary HIV center in southwestern Uganda. There is a need to routinely measure hemoglobin during clinic reviews, and establish mechanisms to retain males initiated on second-line ART in care. The association of anemia and loss to follow up needs to be investigated.
背景：良好的抗逆转录病毒治疗（ART）依从性和治疗保留对于 HIV 护理计划的有效性至关重要。随着撒哈拉以南非洲接受二线 ART 治疗的 HIV 感染者人数不断增加，有必要确定他们的治疗结果和失访率。在这项研究中，我们确定了乌干达西南部一家经验丰富的 HIV 治疗中心接受二线 ART 治疗的患者失访的发生率和预测因素。
方法：这是对乌干达西南部姆巴拉拉地区转诊医院 HIV 诊所电子数据库的回顾性分析。二线 ART 包括至少两种核苷逆转录酶抑制剂和一种强化蛋白酶抑制剂。失访定义为上次就诊后 180 天或更长时间未返回医疗机构进行护理或治疗补充。排除 15 岁以下的儿童后，我们汇总了 2002 年至 2017 年期间开始接受二线 ART 的患者的社会人口统计学、临床和实验室数据。对于缺失数据的变量，我们进行了多重插补。在未调整的双变量分析中 p 值<0.05 的变量被纳入多变量二项式回归模型，使用逐步向后选择程序来描述独立预测失访的因素。
结果：2002 年至 2017 年间，共有 1121 名患者开始接受二线 ART。我们纳入了 924 名参与者的数据，其中 518 名（56.1%）为女性，平均年龄（SD）为 38.4（±10.5）岁，433 名（52.4%）在开始二线 ART 时 CD4 计数小于 100 个/µl。失访的发生率为每 100 人年 26.7 例。男性（调整后的风险比（ARR）=1.8，95%CI 1.5-2.0）p<0.001 和贫血（ARR 1.4，95%CI 1.1-1.6）p<0.001 与失访密切相关。
结论：在乌干达西南部的一家三级 HIV 中心，接受蛋白酶抑制剂为基础的二线 ART 治疗的患者失访率很高。有必要在临床复查期间常规测量血红蛋白，并建立机制，确保开始二线治疗的男性继续接受治疗。需要进一步研究贫血与失访之间的关系。
Bull World Health Organ. 2024-3-1
PLOS Glob Public Health. 2023-10-18
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