Ilagan Danica Joy C, Eitniear Lindsey, Cole Kelli, Duggan Joan, Sahloff Eric
The University of Toledo Medical Center, Toledo, OH, USA.
Division of Infectious Disease, College of Medicine, University of Toledo, Toledo, OH, USA.
Am J Health Syst Pharm. 2021 Jun 29. doi: 10.1093/ajhp/zxab269.
Data support the individual and public health advantages of shortened time intervals between HIV diagnosis, initiation of antiretroviral therapy (ART), and virologic suppression. The time from HIV diagnosis to linkage to care, initiation of ART, and virologic suppression was evaluated in newly diagnosed, ART-naive individuals after structured programmatic changes were implemented to reduce time to virologic suppression (TVS).
The retrospective cohort included newly diagnosed, ART-naive adult patients receiving care in a Midwestern Ryan White Clinic. Study periods were between January 1, 2015, and December 31, 2015 (delayed treatment group) and January 1, 2017, and December 31, 2017 (rapid treatment group). Changes during the intervention time period were related to access to care and ART. The primary outcome of time from HIV diagnosis to virologic suppression was compared between the groups. Secondary outcomes included the time from diagnosis to linkage to care and the time to initiation of ART.
Twenty-four and 35 individuals were included in the control and intervention groups, respectively. Median (interquartile range) time from diagnosis to viral suppression was 137 (77-318) days in the delayed treatment group vs 76.5 (51-151) days in the rapid treatment group (P = 0.021). Time from diagnosis to first clinic visit remained similar (median of 13.5 vs 15 days, P = 0.859), while time from first clinic visit to initiation of ART decreased significantly (median of 15 vs 0 days, P < 0.001).
Time from first clinic visit to ART initiation was significantly shortened in this intervention and was the driving force to decreasing TVS. Additional research into barriers impacting time from diagnosis to linkage to care are needed to further shorten TVS.
数据表明，缩短艾滋病病毒（HIV）诊断、开始抗逆转录病毒治疗（ART）以及实现病毒学抑制之间的时间间隔，对个人健康和公众健康均有益处。在实施结构化项目变更以缩短病毒学抑制时间（TVS）后，对新诊断的、未接受过ART治疗的个体从HIV诊断到获得治疗、开始ART以及实现病毒学抑制的时间进行了评估。
这项回顾性队列研究纳入了在中西部一家瑞安·怀特诊所接受治疗的新诊断的、未接受过ART治疗的成年患者。研究时间段为2015年1月1日至2015年12月31日（延迟治疗组）以及2017年1月1日至2017年12月31日（快速治疗组）。干预期间的变更与获得治疗和ART的机会有关。比较了两组从HIV诊断到病毒学抑制的主要时间结果。次要结果包括从诊断到获得治疗的时间以及开始ART的时间。
对照组和干预组分别纳入了24例和35例个体。延迟治疗组从诊断到病毒抑制的中位（四分位间距）时间为137（77 - 318）天，而快速治疗组为76.5（51 - 151）天（P = 0.021）。从诊断到首次就诊的时间保持相似（中位数分别为13.5天和15天，P = 0.859），而从首次就诊到开始ART的时间显著缩短（中位数分别为15天和0天，P < 0.001）。
在此次干预中，从首次就诊到开始ART的时间显著缩短，这是缩短TVS的驱动力。需要进一步研究影响从诊断到获得治疗时间的障碍，以进一步缩短TVS。
