Behind the cascade: analyzing spatial patterns along the HIV care continuum.
Behind the cascade: analyzing spatial patterns along the HIV care continuum.
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DOI：
10.1097/qai.0b013e3182a90112
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发表时间：
2013-11-01
期刊：
影响因子：
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通讯作者：
Brady KA
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文献类型：
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作者：
Eberhart MG;Yehia BR;Hillier A;Voytek CD;Blank MB;Frank I;Metzger DS;Brady KA
成功的艾滋病毒治疗作为预防需要对个体进行检测、了解其状况、联系并保留在护理中以及抑制病毒。空间分析可能有助于通过确定结果不佳的地理区域来监测艾滋病毒护理。 2008-2009 年费城增强型艾滋病毒/艾滋病报告系统确定的 1,704 名新诊断艾滋病毒患者的回顾性队列，并随访至 2011 年。感兴趣的结果与护理无关，与 90 天内护理无关，不保留在护理中，也没有病毒抑制。使用 K 函数分析空间模式，以确定有针对性的干预的“热点”。回归分析中包括地理成分以及人口因素，以确定它们对每个结果的影响。总体而言，有 1,404 人（82%）需要护理； 75% (1,059/1,404) 在 90 天内链接； 37% (526/1,059) 继续接受护理； 72% (379/526) 实现了病毒抑制。 59 个人口普查区处于“热点”，结果之间没有重叠。居住在当地 K 函数分析确定的地理区域的人更有可能不接受护理 (AOR 1.76 [95% CI 1.30–2.40])、在 90 天内不接受护理 (1.49, 1.12–1.99)、不保留护理 (1.84, 1.39–2.43) 以及不进行病毒抑制 (3.23, 1.87–5.59）比不居住在已确定区域的人要多。这项研究首次将空间模式确定为护理联系、护理保留和病毒抑制的强有力的独立预测因素。空间分析是描述艾滋病毒流行和治疗级联特征的宝贵工具。
Successful HIV treatment as prevention requires individuals to be tested, aware of their status, linked to and retained in care, and virally suppressed. Spatial analysis may be useful for monitoring HIV care by identifying geographic areas with poor outcomes. Retrospective cohort of 1,704 people newly diagnosed with HIV identified from Philadelphia’s Enhanced HIV/AIDS Reporting System in 2008–2009, with follow-up to 2011. Outcomes of interest were not linked to care, not linked to care within 90 days, not retained in care, and not virally suppressed. Spatial patterns were analyzed using K-functions to identify ‘hot spots’ for targeted intervention. Geographic components were included in regression analyses along with demographic factors to determine their impact on each outcome. Overall, 1,404 persons (82%) linked to care; 75% (1,059/1,404) linked within 90 days; 37% (526/1,059) were retained in care; and 72% (379/526) achieved viral suppression. 59 census tracts were in ‘hot spots’, with no overlap between outcomes. Persons residing in geographic areas identified by the local K-function analyses were more likely to not link to care (AOR 1.76 [95% CI 1.30–2.40]), not link to care within 90 days (1.49, 1.12–1.99), not be retained in care (1.84, 1.39–2.43), and not be virally suppressed (3.23, 1.87–5.59) than persons not residing in the identified areas. This study is the first to identify spatial patterns as a strong independent predictor of linkage to care, retention in care, and viral suppression. Spatial analyses are a valuable tool for characterizing the HIV epidemic and treatment cascade.