Akakpo Abla Sefako, Teclessou Julienne Noude, Deku Kodjo, Tchupo Jean-Paul, Wade Souley, Ekouevi Didier Koumavi, Adam Zakilatou, Dagnra Anoumou Yawotsè, Pitché Palokinam
Service de dermato-vénéréologie, Université de Lomé, Togo.
Conseil national de lutte contre le sida et les IST, Togo.
Med Trop Sante Int. 2025 Mar 13;5(1). doi: 10.48327/mtsi.v5i1.2025.664. eCollection 2025 Mar 31.
INTRODUCTION: The aim of our study was to analyze retention in care and survival at 12, 24, and 36 months among people living with HIV (PLWH) on antiretroviral therapy (ART). METHODS: This is a retrospective cross-sectional analysis of a cohort of PLWH aged 15 years and older who started ART. Purposive sampling was used, taking into account the activities of different health centers and budgetary constraints (quantitative approach). In-depth individual interviews and focus groups were also conducted (qualitative approach). RESULTS: During the study period, 2,100 HIV-infected patients were enrolled. The median age of patients was 44 years (interquartile range (IQR) [36-51]), with a statistically significant difference according to sex (p< 0.001), with women being younger than men (42 46 years). The median duration of ART was 5 years (IQR [2-8]) with no statistical difference by gender (p=0.752). At baseline, 20.5% (n=431) and 25.1% (n=509) were lost to follow-up (LTF) 90 days and 28 days after scheduled visit, respectively. There were 146 adult deaths, for a crude mortality rate of 6.9% (95% CI [5.9-8.1]). Approximately 60% of the 158 PLWH randomly selected from our LTF patients could be reached by telephone. They reported that they were still in care. Retention in care was 72.5%, and the probability of retention was 91.6% at 12 months, 87.8% at 24 months, and 78.7% at 60 months. Retention in care was more pronounced among women and more significant among PLWH aged 35 years and older when treatment was initiated in health care facilities offering the full range of activities (care and treatment, active patient search, presence of social mediators). CONCLUSION: Our study, conducted during the Covid-19 pandemic, shows acceptable retention rates in care for PLWH. These results make possible to propose solutions to improve the care program in the country: the harmonization of procedures for tracing PLWH with the implementation of their active search (with the help of community mediators) and the dispensing of ART to PLWH for three or six months.
引言：我们研究的目的是分析接受抗逆转录病毒治疗（ART）的艾滋病毒感染者（PLWH）在12个月、24个月和36个月时的治疗留存率和生存率。 方法：这是一项对15岁及以上开始接受ART治疗的PLWH队列进行的回顾性横断面分析。采用立意抽样法，同时考虑不同健康中心的活动和预算限制（定量方法）。还进行了深入的个人访谈和焦点小组访谈（定性方法）。 结果：在研究期间，共纳入2100名艾滋病毒感染患者。患者的中位年龄为44岁（四分位间距[IQR][36 - 51]），按性别有统计学显著差异（p < 0.001），女性比男性年轻（42对46岁）。ART的中位疗程为5年（IQR[2 - 8]），按性别无统计学差异（p = 0.752）。在基线时，分别有20.5%（n = 431）和25.1%（n = 509）的患者在预定就诊后90天和28天失访（LTF）。有146例成人死亡，粗死亡率为6.9%（95%CI[5.9 - 8.1]）。从我们的失访患者中随机选取的158名PLWH中，约60%可以通过电话联系上。他们报告称仍在接受治疗。治疗留存率为72.5%，12个月时的留存概率为91.6%，24个月时为87.8%，60个月时为78.7%。在提供全方位活动（护理和治疗、积极寻找患者、有社会调解人员）的医疗机构开始治疗时，女性的治疗留存情况更明显，35岁及以上的PLWH更显著。 结论：我们在新冠疫情期间进行的研究表明，PLWH的治疗留存率可接受。这些结果使得有可能提出改善该国护理计划的解决方案：统一追踪PLWH的程序并实施积极寻找（借助社区调解人员），以及为PLWH发放三到六个月的ART药物。
Med Trop Sante Int. 2025-3-13
AIDS Res Hum Retroviruses. 2019
Trop Med Int Health. 2022-6
BMC Public Health. 2021-7-31
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