Ntsame Owono Michèle Marion, Essomeyo Ngue Mebale Magalie, Manomba Boulingui Charleine, Moutombi Ditombi Bridy, Kouna Ndouongo Philomène, Bouyou Akotet Marielle Karine
Service d'infectiologie, Centre hospitalier universitaire de Libreville, Gabon.
Département de médecine et spécialités médicales, Université des sciences de la santé, BP 4000, Gabon.
Med Trop Sante Int. 2025 Feb 11;5(1). doi: 10.48327/mtsi.v5i1.2025.537. eCollection 2025 Mar 31.
Delays in entry to care are a barrier to immediate initiation of antiretroviral therapy (ART) at diagnosis, as recommended by the World Health Organization. The aim of this study was to determine and compare delays in entry into care and associated factors among people living with HIV (PLHIV) seen at two outpatient treatment centers in Libreville between 2012 and 2020.
Retrospective study based on PLHIV records collected from January 2012 to March 2020 at the two largest outpatient treatment centers (CTA) in Libreville, that of the Centre Hospitalier Universitaire de Libreville (CHUL) and that of Nkembo Hospital. Early entry into care was defined as less than 28 days between diagnosis of HIV infection and first consultation at the CTA. Late entry was defined as more than three months. For analysis, patients were divided into two periods: 2012-2015, when treatment initiation was linked to CD4 count, and 2016-2020, the period when the method was introduced in Gabon.
A total of 979 patients were newly treated in the two CTAs, and the records of 672 individuals could be used. In 48.3% of the cases, HIV infection was diagnosed at a late stage (WHO 3 or 4). The median time to entry into care was 1.2 [IQ: 0-3] months after diagnosis of HIV infection. Between 2016 and 2020, 47% entered care in less than 28 days, compared with 35.7% in 2012-2015 (p < 0.01). The percentage of PLHIV with late entry into care was comparable between the two periods (14.4% vs. 15.9% in 2012-2015; p = 0.62). Factors associated with late entry were WHO stage 3, failure to achieve CD4 count, employment, and pregnancy (p<0.05).
In the era of in Libreville, the delay in seeking care is still long. A better understanding of the associated factors and a decentralized, integrated approach to the management of HIV infection would make it possible to achieve the second pillar of "95-95-95" target in Libreville.
正如世界卫生组织所建议的，诊断后延迟接受治疗是立即开始抗逆转录病毒治疗（ART）的一个障碍。本研究的目的是确定并比较2012年至2020年期间在利伯维尔两个门诊治疗中心接受治疗的艾滋病毒感染者（PLHIV）接受治疗的延迟情况及相关因素。
基于2012年1月至2020年3月在利伯维尔两个最大的门诊治疗中心（CTA），即利伯维尔大学中心医院（CHUL）和恩肯博医院收集的PLHIV记录进行回顾性研究。早期接受治疗的定义为艾滋病毒感染诊断与在CTA首次就诊之间少于28天。延迟接受治疗的定义为超过三个月。为进行分析，将患者分为两个时期：2012 - 2015年，治疗开始与CD4细胞计数相关的时期；以及2016 - 2020年，加蓬引入该方法的时期。
两个CTA共有979名患者接受新治疗，672人的记录可用。在48.3%的病例中，艾滋病毒感染诊断为晚期（世界卫生组织3期或4期）。艾滋病毒感染诊断后接受治疗的中位时间为1.2[四分位间距：0 - 3]个月。2016年至2020年期间，47%的患者在不到28天内接受治疗，而2012 - 2015年为35.7%（p < 0.01）。两个时期延迟接受治疗的PLHIV百分比相当（2012 - 2015年为14.4%对15.9%；p = 0.62）。与延迟接受治疗相关的因素有世界卫生组织3期、未达到CD4细胞计数、就业和怀孕（p<0.05）。
在利伯维尔的 时代，寻求治疗的延迟仍然很长。更好地了解相关因素以及采用分散的、综合的艾滋病毒感染管理方法将有可能在利伯维尔实现“95 - 95 - 95”目标的第二支柱。 （注：原文中“in the era of in Libreville”表述不完整，翻译时保留原样）
