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马达加斯加塔那那利佛参考中心艾滋病毒护理中艾滋病毒/艾滋病感染者的回顾性队列分析。

A retrospective cohort analysis of people living with HIV/AIDS enrolled in HIV care at a reference center in Antananarivo, Madagascar.

机构信息

Department of Infectious Diseases, University Hospital Joseph Raseta Befelatanana Antananarivo, Antananarivo, Madagascar.

Faculty of Medicine, University of Antananarivo, Antananarivo, Madagascar.

出版信息

Front Public Health. 2024 Jan 15;11:1329194. doi: 10.3389/fpubh.2023.1329194. eCollection 2023.

DOI:10.3389/fpubh.2023.1329194

PMID:38288430

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10822960/

Abstract

BACKGROUND

The impact of the "Treat all" policy on the individual and in terms of public health is closely related to early diagnosis and retention in care. Patient-level data are scarce in Madagascar. In this study, we aimed to describe the profile of a cohort of newly diagnosed people living with HIV/AIDS (PLHIV), identify their outcomes, and assess factors associated with attrition from care and advanced HIV disease (AHD) at presentation.

METHODS

We conducted a retrospective cohort study of PLHIV aged ≥15 years newly diagnosed at the University Hospital Joseph Raseta Befelatanana Antananarivo from 1 January 2010 to 31 December 2016.

RESULTS

A total of 490 PLHIV were included in the cohort analysis. In total, 67.1% were male. The median age (interquartile range) at enrollment in care was 29 years (24-38). Overall, 36.1% of PLHIV were diagnosed with AHD at baseline. The proportion of patients with WHO stage IV at baseline increased significantly from 3.3% in 2010 to 31% in 2016 ( = 0.001 for trend). The probability of retention in care after the diagnosis at 12 months, 24 months, and 36 months was 71.8%, 65.5%, and 61.3%, respectively. Age ≥ 40 years (aHR: 1.55; 95% CI: 1.05-2.29; = 0.026), low level of education (aHR:1.62; 95% CI: 1.11-2.36; = 0,013), unspecified level of education (aHR:2.18; 95% CI: 1.37-3.47; = 0.001) and unemployment (aHR:1.52; 95% CI: 1.07-2.16; = 0.019) were independently associated with attrition from care. Factors associated with AHD at baseline were age ≥ 40 (aOR: 2.77; 95% CI: 1.38-5.57, = 0.004), unspecified level of education (aOR: 3.80; 95% CI: 1.58-9.16, = 0.003) and presence of clinical symptoms at baseline (aOR: 23.81; 95% CI: 10.7-52.98; < 0.001). Sex workers were independently less likely to have an AHD at presentation (aOR: 0.23; 95% CI: 0.05-0.96, = 0.044).

CONCLUSION

Sociodemographic determinants influenced retention in care more than clinical factors. The presence of clinical symptoms and sociodemographic determinants were the main factors associated with AHD at baseline.

摘要

背景

“全面治疗”政策对个人和公共卫生的影响与早期诊断和持续治疗密切相关。马达加斯加的患者水平数据很少。本研究旨在描述一组新诊断的艾滋病毒感染者/艾滋病患者（PLHIV）的特征，确定其结局，并评估与治疗中断和基线时出现的晚期 HIV 疾病（AHD）相关的因素。

方法

我们对 2010 年 1 月 1 日至 2016 年 12 月 31 日在塔那那利佛约瑟夫·拉塞塔贝法莱坦纳纳大学医院新诊断为年龄≥15 岁的 PLHIV 进行了回顾性队列研究。

结果

共有 490 名 PLHIV 被纳入队列分析。其中，67.1%为男性。入组时的中位年龄（四分位间距）为 29 岁（24-38）。总体而言，36.1%的 PLHIV 在基线时被诊断为 AHD。基线时出现世界卫生组织（WHO）第四阶段的患者比例从 2010 年的 3.3%显著增加到 2016 年的 31%（趋势检验， = 0.001）。诊断后 12 个月、24 个月和 36 个月的保留治疗的概率分别为 71.8%、65.5%和 61.3%。年龄≥40 岁（aHR：1.55；95%CI：1.05-2.29； = 0.026）、低教育水平（aHR：1.62；95%CI：1.11-2.36； = 0.013）、未指定教育水平（aHR：2.18；95%CI：1.37-3.47； = 0.001）和失业（aHR：1.52；95%CI：1.07-2.16； = 0.019）与治疗中断独立相关。与基线时 AHD 相关的因素包括年龄≥40 岁（aOR：2.77；95%CI：1.38-5.57， = 0.004）、未指定教育水平（aOR：3.80；95%CI：1.58-9.16， = 0.003）和基线时存在临床症状（aOR：23.81；95%CI：10.7-52.98； < 0.001）。性工作者在基线时出现 AHD 的可能性独立降低（aOR：0.23；95%CI：0.05-0.96， = 0.044）。