Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA.
Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.
BMJ Open. 2021 Dec 2;11(12):e055712. doi: 10.1136/bmjopen-2021-055712.
OBJECTIVES: For persons living with HIV (PLWH) in long-term care, clinic transfers are common and influence sustained engagement in HIV care, as they are associated with significant time out-of-care, low CD4 count, and unsuppressed viral load on re-entry. Despite the geospatial nature of clinic transfers, there exist limited data on the geospatial trends of clinic transfers to guide intervention development. In this study, we investigate the geospatial characteristics and trends of clinic transfers among PLWH on antiretroviral therapy (ART) in the Western Cape Province of South Africa. DESIGN: Retrospective spatial analysis. SETTING: PLWH who initiated ART treatment between 2012 and 2016 in South Africa's Western Cape Province were followed from ART initiation to their last visit prior to 2017. Deidentified electronic medical records from all public clinical, pharmacy, and laboratory visits in the Western Cape were linked across space and time using a unique patient identifier number. PARTICIPANTS: 4176 ART initiators in South Africa (68% women). METHODS: We defined a clinic transfer as any switch between health facilities that occurred on different days and measured the distance between facilities using geodesic distance. We constructed network flow maps to evaluate geospatial trends in clinic transfers over time, both for individuals' first transfer and overall. RESULTS: Two-thirds of ART initiators transferred health facilities at least once during follow-up. Median distance between all clinic transfer origins and destinations among participants was 8.6 km. Participant transfers were heavily clustered around Cape Town. There was a positive association between time on ART and clinic transfer distance, both among participants' first transfers and overall. CONCLUSION: This study is among the first to examine geospatial trends in clinic transfers over time among PLWH. Our results make clear that clinic transfers are common and can cluster in urban areas, necessitating better integrated health information systems and HIV care.
目的：对于长期护理中的艾滋病毒感染者（PLWH），诊所转移很常见，并且会影响艾滋病毒护理的持续参与，因为它们与大量脱离护理时间、低 CD4 计数以及重新进入时未抑制的病毒载量有关。尽管诊所转移具有地理空间性质，但关于诊所转移的地理空间趋势的数据有限，无法为干预措施的制定提供指导。在这项研究中，我们调查了南非西开普省接受抗逆转录病毒疗法（ART）的 PLWH 中诊所转移的地理空间特征和趋势。
设计：回顾性空间分析。
地点：从 2012 年至 2016 年期间在南非西开普省开始接受 ART 治疗的 PLWH 从开始接受 ART 治疗到 2017 年之前的最后一次就诊进行了随访。利用唯一的患者识别号码，将西开普省所有公共临床、药房和实验室就诊的匿名电子病历进行跨空间和时间链接。
参与者：南非 4176 名 ART 启动者（68%为女性）。
方法：我们将诊所转移定义为任何在不同日期之间发生的医疗机构之间的切换，并使用大地测量距离测量设施之间的距离。我们构建了网络流量图，以评估个体首次转移和总体转移的时间推移中的诊所转移的地理空间趋势。
结果：在随访期间，三分之二的 ART 启动者至少转移过一次医疗机构。参与者中所有诊所转移起点和终点之间的中位数距离为 8.6 公里。参与者的转移主要集中在开普敦周围。在参与者的首次转移和总体转移中，ART 时间与诊所转移距离之间均存在正相关关系。
结论：这项研究是首次检查 PLWH 中随时间推移的诊所转移的地理空间趋势。我们的研究结果清楚地表明，诊所转移很常见，并且可能集中在城市地区，这需要更好的综合健康信息系统和艾滋病毒护理。
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