东非地区将艾滋病毒/非传染性疾病综合护理干预对患者持续护理和临床结局的长期影响。

Long-term impact of an integrated HIV/non-communicable disease care intervention on patient retention in care and clinical outcomes in East Africa.

机构信息

MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.

Institute for Global Health, University College London, London, UK.

出版信息

Trop Med Int Health. 2024 Aug;29(8):723-730. doi: 10.1111/tmi.14026. Epub 2024 Jul 8.

DOI:10.1111/tmi.14026

PMID:38973259

Abstract

OBJECTIVE

To describe rates of retention in care and control of hypertension, diabetes and HIV among participants receiving integrated care services for a period of up to 24 months in East Africa.

METHODS

Between 5 October 2018 and 23 June 2019 participants enrolled into a prospective cohort study evaluating the feasibility of integrated care delivery for HIV, diabetes and hypertension from a single point of care in Tanzania and Uganda (MOCCA study). Integrated care clinics were established in 10 primary healthcare facilities and care was provided routinely according to national guidelines. Initial follow-up was 12 months. Outcomes were rates of retention in care, proportions of participants with controlled hypertension (blood pressure <140/90 mmHg), diabetes (fasting blood glucose <7.0 mmol/L) and HIV (plasma viral load <1000 copies/ml). The study coincided with the COVID-19 pandemic response. Afterwards, all participants were approached for extended follow-up by a further 12 months in the same clinics. We evaluated outcomes of the cohort at the end of long-term follow-up.

RESULTS

The MOCCA study enrolled 2273 participants of whom 1911 (84.5%) were retained in care after a median follow-up of 8 months (Interquartile range: 6.8-10.7). Among these, 1283/1911 (67.1%) enrolled for a further year of follow-up, 458 (24.0%) were unreachable, 71 (3.7%) reverted to vertical clinics (clinics providing services dedicated to study conditions), 31 (1.6%) died and 68 (3.6%) refused participation. Among participants who enrolled for longer follow-up, mean age was 51.4 ± 11.7 years, 930 (72.5%) were female and 509 (39.7%) had multiple chronic conditions. Overall, 1236 (96.3%) [95% confidence interval 95.2%-97.3%] participants were retained in care, representing 1236/2273 (54.3%) [52.3%-56.4%] of participants ever enrolled in the study. Controlled hypertension, diabetes and HIV at the end of follow-up was, 331/618 (53.6%) [49.5%-57.5%], 112/354 (31.6%) [26.8%-36.8%] and 332/343 (96.7%) [94.3%-98.4%] respectively.

CONCLUSION

Integrated care can achieve high rates of retention in care long term, but control of blood pressure and blood sugar remains low.

摘要

目的

描述在东非接受长达 24 个月的综合护理服务的参与者保持护理和控制高血压、糖尿病和艾滋病毒的比例。

方法

2018 年 10 月 5 日至 2019 年 6 月 23 日，参与者参加了一项前瞻性队列研究，评估坦桑尼亚和乌干达从单一护理点提供艾滋病毒、糖尿病和高血压综合护理服务的可行性（MOCCA 研究）。在 10 个初级保健设施中设立了综合护理诊所，并根据国家指南常规提供护理。最初的随访时间为 12 个月。结果为保持护理的比例、高血压（血压<140/90mmHg）、糖尿病（空腹血糖<7.0mmol/L）和艾滋病毒（血浆病毒载量<1000 拷贝/ml）得到控制的参与者比例。该研究恰逢 COVID-19 大流行应对期间。之后，所有参与者都在同一诊所接受了长达 12 个月的额外随访。我们在长期随访结束时评估了队列的结果。

结果

MOCCA 研究共纳入 2273 名参与者，其中 1911 名（84.5%）在中位随访 8 个月（四分位距：6.8-10.7）后保持护理。其中，1283 名/1911 名（67.1%）参加了为期一年的随访，458 名（24.0%）无法联系，71 名（3.7%）转回垂直诊所（提供专门研究条件服务的诊所），31 名（1.6%）死亡，68 名（3.6%）拒绝参与。在参加更长时间随访的参与者中，平均年龄为 51.4±11.7 岁，930 名（72.5%）为女性，509 名（39.7%）有多种慢性疾病。总体而言，1236 名（96.3%）[95%置信区间 95.2%-97.3%]参与者保持护理，代表 2273 名参与者中 1236 名（54.3%）[52.3%-56.4%]曾参加过该研究。随访结束时高血压、糖尿病和艾滋病毒得到控制的比例分别为 331/618（53.6%）[49.5%-57.5%]、112/354（31.6%）[26.8%-36.8%]和 332/343（96.7%）[94.3%-98.4%]。