提高博茨瓦纳的当日抗逆转录病毒治疗效果：多方面国家干预的影响。
Improving same-day antiretroviral therapy in Botswana: effects of a multifaceted national intervention.
机构信息
Botswana-University of Maryland School of Medicine Health Initiative (Bummhi), Gaborone, Botswana.
Center for International Health, Education, and Biosecurity, Institute of Human Virology-University of Maryland School of Medicine, Baltimore, Maryland, USA.
出版信息
AIDS. 2022 Mar 15;36(4):533-538. doi: 10.1097/QAD.0000000000003139.
BACKGROUND
In 2019, the Botswana Ministry of Health and Wellness (MOHW) implemented an HIV national Reboot program, which was needed for refocusing and intensifying efforts for achieving epidemic control. The strategies deployed as part of Reboot were reviewed and evaluated for their effect on same-day and within-seven-days (fast-track initiation) antiretroviral therapy (ART) initiation among adults newly identified with HIV.
METHODS
We conducted a retrospective cohort analysis of patients aged 18 years or older who were newly diagnosed with HIV from October 2018 to September 2019 across 41 health facilities. We used generalized linear mixed models, adjusting for clustering by facility, to assess the association of the Reboot with same-day or within-seven-days ART initiation (fast-track initiation).
RESULTS
From October 2018 to January 2019, 28% (636/2269) of newly diagnosed HIV patients were initiated the same day of diagnosis, and 56% (1260/2269) were initiated within seven days. Following the launch of Reboot (February to September 2019), 59% (2092/3553) were initiated the same day of diagnosis, and 77% (2752/3553) were initiated within seven days. Clients were 2.08 (adjusted risk ratio 95% confidence interval 1.79-2.43) times more likely to be initiated the same day of diagnosis and 1.39 (adjusted risk ratio 95% confidence interval 1.28-1.52) times more likely to be initiated within seven days than before Reboot after adjusting for sex and age.
CONCLUSION
In Botswana, a multifaceted national intervention improved timely ART initiation. Identifying and implementing different client-centered strategies to facilitate ART initiation is critical to preventing AIDS-related complications and prevent ongoing transmission.
背景
2019 年，博茨瓦纳卫生部（MOHW）实施了一项艾滋病毒国家重启计划，该计划需要重新聚焦并加强努力，以实现疫情控制。对作为重启一部分部署的战略进行了审查和评估，以了解其对新诊断出艾滋病毒的成年人同日和七天内（快速启动）开始抗逆转录病毒治疗（ART）的影响。
方法
我们对 2018 年 10 月至 2019 年 9 月期间在 41 个卫生机构中新诊断出艾滋病毒的年龄在 18 岁或以上的患者进行了回顾性队列分析。我们使用广义线性混合模型，根据设施进行聚类调整，评估重启与同日或七天内开始 ART（快速启动）的关联。
结果
从 2018 年 10 月至 2019 年 1 月，28%（636/2269）新诊断出的艾滋病毒患者在诊断当天开始治疗，56%（1260/2269）在七天内开始治疗。在重启启动后（2019 年 2 月至 9 月），59%（2092/3553）在诊断当天开始治疗，77%（2752/3553）在七天内开始治疗。调整性别和年龄后，与重启前相比，患者在诊断当天开始治疗的可能性高 2.08 倍（调整后的风险比，95%置信区间 1.79-2.43），在七天内开始治疗的可能性高 1.39 倍（调整后的风险比，95%置信区间 1.28-1.52）。
结论
在博茨瓦纳，一项多方面的国家干预措施改善了及时开始抗逆转录病毒治疗。确定和实施不同的以客户为中心的策略，以促进抗逆转录病毒治疗的启动，对于预防艾滋病相关并发症和防止持续传播至关重要。
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