Idindili Boniphace M, King Simon J, Stolka Kristen, Mashasi Irene, Bashosho Philberth, Karungula Happy, Chintowa Florida, Mwakabole Godfrey, Ashburn Kimberly, Do Barbara, Goco Norman
RTI International, Tanzania.
RTI International, United States.
South Afr J HIV Med. 2018 Jun 14;19(1):777. doi: 10.4102/sajhivmed.v19i1.777. eCollection 2018.
To assess how the infrastructure improvements supported by the US Centers for Disease Control and Prevention (CDC) and the United States President's Emergency Plan for AIDS Relief (PEPFAR) contributed to facility-level quarterly and annual new patient enrolment in HIV care and treatment and antiretroviral therapy (ART) uptake and retention in care.
Aggregate quarterly and annual facility-based HIV care and treatment data from the CDC-managed PEPFAR Reporting Online and Management Information System database collected between 2005 and 2012 were analysed for the 11 rural and 32 urban facilities that met the eligibility criteria. Infrastructure improvements, including both renovations and new construction, occurred on different dates for the facilities; therefore, data were adjusted such that pre- and post-infrastructure improvements were aligned and date-time was ignored. The analysis calculated the mean (95% confidence interval) number of patients per facility who were (1) newly enrolled in HIV care, (2) patients initiated on ART, (3) patients retained in care, defined as alive and on ART, and (4) reasons for attrition, defined as transferred out, lost to follow-up, deceased or stopped ART.
The overall mean number of adult patients newly enrolled in HIV care clinics per quarter declined from 187.7 (151.4-223.9) to 135.2 (117.4-152.9) after infrastructure improvements but was not statistically significant ( = 0.20). However, the mean number of patients who were alive and remained on ART increased from 193.2 (145.3-241.1) to 273.2 (219.0-327.3) after improvements in both rural and urban facilities, although not significantly ( = 0.59). A similar picture was observed for overall paediatric enrolment and retention in care. Health facility-specific case studies show variations in new patient enrolment and retention in care between health facilities depending on the catchment area, population HIV prevalence and coverage of ART facilities. Regarding attrition, the mean number of adult patients lost to follow-up changed from 76.6 (20.8-132.3) to 139.4 (79.6-199.1) ( = 0.65) among rural facilities, while the mean number of children lost to follow-up increased significantly from 3.4 (0.5-6.3) to 8.7 (5.0-12.3) ( = 0.02) after improvements.
Patient retention in care improved in HIV care and treatment facilities with infrastructure improvements. However, the overall number of patients newly enrolled and initiated on ART declined and attrition increased in facilities after improvements.
评估美国疾病控制与预防中心（CDC）及美国总统艾滋病紧急救援计划（PEPFAR）所支持的基础设施改善如何促进了医疗机构层面每季度和每年的艾滋病护理与治疗新患者登记，以及抗逆转录病毒疗法（ART）的采用和治疗留存率。
对2005年至2012年期间从CDC管理的PEPFAR在线报告与管理信息系统数据库收集的符合资格标准的11家农村医疗机构和32家城市医疗机构的基于机构的艾滋病护理与治疗季度及年度汇总数据进行分析。基础设施改善包括翻新和新建，不同机构的改善时间不同；因此，对数据进行了调整，以使基础设施改善前后的数据对齐，并忽略日期时间。分析计算了每家机构的平均（95%置信区间）患者数量，这些患者包括：（1）新登记接受艾滋病护理的患者；（2）开始接受抗逆转录病毒疗法的患者；（3）留存于治疗中的患者，定义为存活且正在接受抗逆转录病毒疗法；（4）流失原因，定义为转出、失访、死亡或停止抗逆转录病毒疗法。
基础设施改善后，艾滋病护理诊所每季度新登记的成年患者总数均值从187.7（151.4 - 223.9）降至135.2（117.4 - 152.9），但差异无统计学意义（P = 0.20）。然而，农村和城市医疗机构改善后，存活且继续接受抗逆转录病毒疗法的患者均值从193.2（145.3 - 241.1）增至273.2（219.0 - 327.3），不过差异也不显著（P = 0.59）。在总体儿科登记和治疗留存方面也观察到类似情况。针对医疗机构的具体案例研究表明，不同医疗机构在新患者登记和治疗留存方面存在差异，这取决于服务区域、人群艾滋病患病率以及抗逆转录病毒疗法设施的覆盖情况。关于流失情况，农村医疗机构中失访的成年患者均值从76.6（20.8 - 132.3）变为139.4（79.6 - 199.1）（P = 0.65）；而改善后，失访儿童的均值从3.4（0.5 - 6.3）显著增至8.7（5.0 - 12.3）（P = 0.02）。
基础设施得到改善的艾滋病护理与治疗机构中，治疗留存率有所提高。然而，改善后机构中新登记和开始接受抗逆转录病毒疗法的患者总数下降，且流失情况增加。
