Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa.
Department of Global Health & Infection, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9PX, UK.
Ecohealth. 2023 Jun;20(2):178-193. doi: 10.1007/s10393-023-01647-6. Epub 2023 Jul 31.
This analysis investigates the relationship between drought and antiretroviral treatment (ART) adherence and retention in HIV care in the Hlabisa sub-district, KwaZulu-Natal, South Africa. Data on drought and ART adherence and retention were collated for the study period 2010-2019. Drought was quantified using the 3-month Standard Precipitation Evapotranspiration Index (SPEI) and Standard Precipitation Index (SPI) from station data. Adherence, proxied by the Medication Possession Ratio (MPR), and retention data were obtained from the public ART programme database. MPR and retention were calculated from individuals aged 15-59 years who initiated ART between January 2010 and December 2018 and visited clinic through February 2019. Between 01 January 2010 and 31 December 2018, 40,714 individuals started ART in the sub-district and made 1,022,760 ART visits. The SPI showed that 2014-2016 were dry years, with partial recovery after 2016 in the wet years. In the period from 2010 to 2012, mean 6-month MPR increased from 0.85 in July 2010 to a high of 0.92 in December 2012. MPR then decreased steadily through 2013 and 2014 to 0.78 by December 2014. The mean proportion retained in care 6 months after starting ART showed similar trends to MPR, increasing from 86.9% in July 2010 to 91.4% in December 2012. Retention then decreased through 2013, with evidence of a pronounced drop in January 2014 when the odds of retention decreased by 30% (OR = 0.70, CI = 0.53-0.92, P = 0.01) relative to the end of 2013. Adherence and retention in care decreased during the drought years.
本分析研究了南非夸祖鲁-纳塔尔省赫拉布萨次区域干旱与艾滋病毒治疗（ART）依从性和保留之间的关系。研究期间 2010-2019 年收集了干旱和 ART 依从性和保留的数据。使用来自站数据的三个月标准降水蒸散指数（SPEI）和标准降水指数（SPI）量化干旱。通过药物持有率（MPR）代理的依从性和保留数据来自公共 ART 计划数据库获得。MPR 和保留是从 2010 年 1 月至 2018 年 12 月期间开始 ART 并于 2019 年 2 月就诊的年龄在 15-59 岁的个体中计算得出的。2010 年 1 月 1 日至 2018 年 12 月 31 日，该次区域有 40714 人开始接受 ART，就诊 1022760 次。SPI 显示，2014-2016 年为干旱年份，2016 年后部分年份有所恢复。在 2010 年至 2012 年期间，6 个月的平均 MPR 从 2010 年 7 月的 0.85 增加到 2012 年 12 月的 0.92 的高点。然后，MPR 在 2013 年和 2014 年稳步下降，到 2014 年 12 月降至 0.78。开始 ART 后 6 个月保留在护理中的平均比例显示出与 MPR 相似的趋势，从 2010 年 7 月的 86.9%增加到 2012 年 12 月的 91.4%。然后，保留率在 2013 年下降，2014 年 1 月的保留率明显下降，下降了 30%（OR=0.70，CI=0.53-0.92，P=0.01）与 2013 年底相比。在干旱年份，依从性和护理保留率下降。
