Department of Global Health, University of Washington, Seattle, WA.
Department of Medicine, University of Washington, Seattle, WA.
J Acquir Immune Defic Syndr. 2023 Jun 1;93(2):126-133. doi: 10.1097/QAI.0000000000003176.
To determine whether the Centralized Chronic Medication Dispensing and Distribution (CCMDD) program in South Africa's differentiated ART delivery model affects clinical outcomes, we assessed viral load (VL) suppression and retention in care between patients participating in the program and those receiving the clinic-based standard of care.
Clinically stable people living with HIV (PLHIV) eligible for differentiated care were referred to the national CCMDD program and followed up for up to 6 months. In this secondary analysis of trial cohort data, we estimated the association between routine patient participation in the CCMDD program and their clinical outcomes of viral suppression (<200 copies/mL) and retention in care.
Among 390 PLHIV, 236 (61%) were assessed for CCMDD eligibility; 144 (37%) were eligible, and 116 (30%) participated in the CCMDD program. Participants obtained their ART in a timely manner at 93% (265/286) of CCMDD visits. VL suppression and retention in care was very similar among CCMDD-eligible patients who participated in the program compared with patients who did not participate in the program (aRR: 1.03; 95% CI: 0.94-1.12). VL suppression alone (aRR: 1.02; 95% CI: 0.97-1.08) and retention in care alone (aRR: 1.03; 95% CI: 0.95-1.12) were also similar between CCMDD-eligible PLHIV who participated in the program and those who did not.
The CCMDD program successfully facilitated differentiated care among clinically stable participants. PLHIV participating in the CCMDD program maintained a high proportion of viral suppression and retention in care, indicating that community-based ART delivery model did not negatively affect their HIV care outcomes.
为了确定南非差异化抗逆转录病毒治疗（ART）模式下的集中式慢性病配药和分发（CCMDD）计划是否会影响临床结局，我们评估了参与该计划的患者与接受诊所标准护理的患者之间病毒载量（VL）抑制和护理保留率。
符合差异化护理标准的临床稳定的艾滋病毒感染者（PLHIV）被转介到国家 CCMDD 计划，并进行了长达 6 个月的随访。在这项试验队列数据的二次分析中，我们评估了患者常规参与 CCMDD 计划与他们的病毒抑制（<200 拷贝/毫升）和护理保留的临床结局之间的关联。
在 390 名 PLHIV 中，有 236 名（61%）评估了 CCMDD 的资格；144 名（37%）符合条件，116 名（30%）参加了 CCMDD 计划。在 93%（265/286）的 CCMDD 就诊中，参与者及时获得了他们的抗逆转录病毒药物。与未参加该计划的患者相比，参加该计划的 CCMDD 合格患者的病毒抑制和护理保留率非常相似（调整后的比值比[aRR]：1.03；95%置信区间[CI]：0.94-1.12）。仅病毒抑制（aRR：1.02；95% CI：0.97-1.08）和仅护理保留（aRR：1.03；95% CI：0.95-1.12）在参加和未参加 CCMDD 计划的 CCMDD 合格 PLHIV 之间也相似。
CCMDD 计划成功地促进了临床稳定参与者的差异化护理。参加 CCMDD 计划的 PLHIV 保持了较高的病毒抑制和护理保留率，表明基于社区的抗逆转录病毒治疗提供模式并未对他们的艾滋病毒护理结局产生负面影响。
