Understanding reasons for and outcomes of patients lost to follow-up in antiretroviral therapy programs in Africa through a sampling-based approach.
Understanding reasons for and outcomes of patients lost to follow-up in antiretroviral therapy programs in Africa through a sampling-based approach.
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DOI：
10.1097/qai.0b013e3181b843f0
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发表时间：
2010-03
期刊：
影响因子：
--
通讯作者：
Martin JN
中科院分区：
文献类型：
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作者：
Geng EH;Bangsberg DR;Musinguzi N;Emenyonu N;Bwana MB;Yiannoutsos CT;Glidden DV;Deeks SG;Martin JN
在非洲，开始抗逆转录病毒治疗（ART）后的随访损失很常见，这是了解新兴治疗方案有效性的一个重大障碍。我们试图通过一种基于抽样的方法来描述失去随访的患者的原因和结果。队列研究。我们寻找并采访了社区中有代表性的失散患者或密切的线人，以确定失散患者的原因和结果。2004年1月1日至2007年9月30日期间，乌干达姆巴拉拉有三千六百二十八名艾滋病毒感染者开始接受抗逆转录病毒治疗。随访丢失829例（1年、2年和3年累计发病率分别为16%、30%和39%）。我们在社区中寻找了128例丢失患者的代表性样本，并确定了111例（87%）的生命状态。最主要的原因包括缺乏交通或金钱以及工作/照顾孩子的责任。在通过追踪确定生命状态的111例失联患者中，发生32例死亡（1年累计发病率36%）；最后一次诊所访问后不久死亡率最高。抗逆转录病毒治疗前CD4+ t细胞计数较低、年龄较大、低血压和最后一次就诊时出现中枢神经系统综合征预示着死亡。在直接接受采访的患者中，83%在另一家诊所接受治疗，71%仍在使用抗逆转录病毒治疗。社会结构因素是丧失随访的主要原因。失踪者的结果各不相同：死亡和转移到其他诊所都很常见。追踪失联患者的样本是了解失联患者随访的具体原因和结果的有效方法。
Losses to follow-up after initiation of antiretroviral therapy (ART) are common in Africa and are a considerable obstacle to understanding the effectiveness of nascent treatment programs. We sought to characterize, through a sampling-based approach, reasons for and outcomes of patients who become lost to follow-up. Cohort study. We searched for and interviewed a representative sample of lost patients or close informants in the community to determine reasons for and outcomes among lost patients. Three thousand six hundred twenty-eight HIV-infected adults initiated ART between January 1, 2004 and September 30, 2007 in Mbarara, Uganda. Eight hundred twenty-nine became lost to follow-up (cumulative incidence at 1, 2, and 3 years of 16%, 30%, and 39%). We sought a representative sample of 128 lost patients in the community and ascertained vital status in 111 (87%). Top reasons for loss included lack of transportation or money and work/child care responsibilities. Among the 111 lost patients who had their vital status ascertained through tracking, 32 deaths occurred (cumulative 1-year incidence 36%); mortality was highest shortly after the last clinic visit. Lower pre-ART CD4+ T-cell count, older age, low blood pressure, and a central nervous system syndrome at the last clinic visit predicted deaths. Of patients directly interviewed, 83% were in care at another clinic and 71% were still using ART. Sociostructural factors are the primary reasons for loss to follow-up. Outcomes among the lost are heterogeneous: both deaths and transfers to other clinics were common. Tracking a sample of lost patients is an efficient means for programs to understand site-specific reasons for and outcomes among patients lost to follow-up.