Implementation and Operational Research: Impact of Nurse-Targeted Care on HIV Outcomes Among Immunocompromised Persons: A Before-After Study in Uganda.
Implementation and Operational Research: Impact of Nurse-Targeted Care on HIV Outcomes Among Immunocompromised Persons: A Before-After Study in Uganda.
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DOI：
10.1097/qai.0000000000001002
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发表时间：
2016-06-01
期刊：
影响因子：
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通讯作者：
Manabe YC
中科院分区：
文献类型：
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作者：
Kiragga AN;Nalintya E;Morawski BM;Kigozi J;Park BJ;Kaplan JE;Boulware DR;Meya DB;Manabe YC
在撒哈拉以南非洲，改善患有严重免疫功能低下且发病率和死亡率较高的艾滋病病毒感染者的治疗效果仍然是一个重要问题。我们试图评估以诊所为基础的有针对性的护士护理对严重免疫功能低下的艾滋病病毒感染者开始抗逆转录病毒治疗（ART）和保持治疗的影响。
该研究纳入了乌干达坎帕拉7家城市诊所登记的未接受过抗逆转录病毒治疗且CD4细胞计数<100个/微升的患者。回顾性收集了2011年7月至12月入组患者的数据（常规护理队列）。2012年7月至2013年9月期间，每个诊所额外聘请了一名护士（护士顾问队列），以识别新患者、加快开始抗逆转录病毒治疗并追踪失访患者。我们比较了两个队列开始抗逆转录病毒治疗的时间以及6个月的治疗保持情况，并使用广义线性模型来估计保持治疗的相对风险。
该研究在常规护理队列中纳入了258名患者，在护士顾问队列中纳入了593名患者。开始抗逆转录病毒治疗的患者比例从常规护理队列中的190人（73.6%）增加到护士顾问队列中的506人（85.3%）（p<0.001）。在6个月时，常规护理队列中有62%的患者继续接受治疗，而护士顾问队列中这一比例为76%（p = 0.001）。与常规护理队列相比，护士顾问队列中患者继续接受治疗的可能性增加了21%（相对风险1.21，95%置信区间，1.09 - 1.34）。
在公共门诊医疗机构对严重免疫功能低下的艾滋病病毒感染患者实施有针对性的由护士主导的护理，可缩短开始抗逆转录病毒治疗的时间并提高治疗保持率。
Improving HIV outcomes among severely immunocompromised HIV-infected persons who have increased morbidity and mortality remains an important issue in sub-Saharan Africa. We sought to evaluate the impact of targeted clinic- based nurse care on ART initiation and retention among severely immunocompromised HIV-infected persons. The study included ART-naïve patients with CD4<100 cells/μL registered in seven urban clinics in Kampala, Uganda. Data were retrospectively collected on patients enrolled from July to December 2011 (routine care cohort). Between July 2012 and September 2013, one additional nurse per clinic was hired (nurse counselor cohort) to identify new patients, expedite ART initiation and trace those loss-to-follow-up. We compared time to ART initiation and 6-month retention in care between cohorts and used a generalized linear model to estimate the relative risk of retention. The study included 258 patients in the routine care cohort and 593 in the nurse counselor cohort. The proportion of patients who initiated ART increased from 190 (73.6%) in the routine care cohort to 506 (85.3%) in the nurse counselor cohort (p<0.001). At 6 months, 62% of the routine care cohort were retained in care versus 76% in the nurse counselor cohort (p=0.001). A 21% increase in likelihood of retention in the nurse counselor cohort (relative risk 1.21, 95% CI, 1.09–1.34) compared with the routine care cohort was observed. Implementation of targeted nurse–led care of severely immunocompromised HIV-infected patients in public outpatient health care facilities resulted in decreased time to ART initiation and increased retention.