Blugerman Gabriela Alejandra, Valiente José Antonio, Cesar Carina, Yamamoto Cleyton, Sued Omar, Cahn Pedro
División Infectología, Hospital General de Agudos Juan A. Fernández, Buenos Aires, Argentina.
Fundación Huésped, Buenos Aires, Argentina.
Actual SIDA Infectol. 2018 Dec;26(98):54-60. doi: 10.52226/revista.v26i98.21.
Distance from patient's home to the hospital has been proposed as one of the limiting factors for patient's retention in care.
Retrospective cohort study of HIV+ patients 18 years or older who had their first clinical visit between 2011 and 2013 at a reference center in Buenos Aires, Argentina. Patients were considered to be retained in care if they had>=1 clinical visit, laboratory markers (VL and/or CD4 count) and/or ARVs pick-up during the year after their first clinical visit. Each patient address's latitude-longitude was obtained using Google Maps web service. Home-hospital distance and travel time were obtained with Google Maps Distance Matrix API service.
Of 1020 patients who started follow-up, 15 died and 158 were transferred to another site. Of the remaining, 816 (96.3%) had identifiable address in their electronic medical record. Median age at the time of the first visit was 33 (IQR 27-41) years, 654 (77.9%) patients were male. Median home-hospital distance was 10.3 (IQR 4.4-34.7) km and median travel time was 58.5 (IQR 35-102.5) minutes. 730 patients (89.5%; CI 87.1-91.5%) remained in follow-up after 1 year of their first visit. We didńt find association between travel time and home-hospital distance with retention in this population.
In our study, distance between home and the care center was not associated with lower retention one year after first visit in adult HIV patients attending a public hospital.
患者住所与医院的距离被认为是影响患者持续接受治疗的限制因素之一。
对2011年至2013年期间在阿根廷布宜诺斯艾利斯一家参考中心首次进行临床就诊的18岁及以上HIV阳性患者进行回顾性队列研究。如果患者在首次临床就诊后的一年内有≥1次临床就诊、实验室检查指标（病毒载量和/或CD4细胞计数）和/或抗逆转录病毒药物领取记录，则被视为持续接受治疗。使用谷歌地图网络服务获取每位患者住址的经纬度。通过谷歌地图距离矩阵应用程序编程接口服务获取住所到医院的距离和出行时间。
在开始随访的1020名患者中，15人死亡，158人转至其他机构。其余患者中，816人（96.3%）在其电子病历中有可识别的地址。首次就诊时的中位年龄为33岁（四分位间距27 - 41岁），654名（77.9%）患者为男性。住所到医院的中位距离为10.3千米（四分位间距4.4 - 34.7千米），中位出行时间为58.5分钟（四分位间距35 - 102.5分钟）。首次就诊1年后，730名患者（89.5%；置信区间87.1 - 91.5%）仍在随访中。我们未发现该人群的出行时间和住所到医院的距离与持续接受治疗之间存在关联。
在我们的研究中，对于在公立医院就诊的成年HIV患者，首次就诊一年后，住所与治疗中心之间的距离与较低的持续治疗率无关。
