Disengagement and reengagement of HIV continuum of care in a single center cohort in northern Italy
Disengagement and reengagement of HIV continuum of care in a single center cohort in northern Italy
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DOI：
10.1080/15284336.2019.1595887
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发表时间：
2019-01-02
影响因子：
1.6
通讯作者：
Quiros-Roldan, Eugenia
中科院分区：
文献类型：
--
作者：
Comelli, Agnese;Izzo, Ilaria;Quiros-Roldan, Eugenia
背景：尽管艾滋病毒护理取得了进展，但坚持后续行动仍然至关重要。脱离接触会损害艾滋病毒护理的效益，越来越多的数据表明，不继续护理与更糟糕的结果有关，这促使公共卫生机构将继续护理视为抗击艾滋病毒流行病的一种新工具。这次回顾展的目的，一项观察性研究旨在估计我们的HIV队列中脱离和重新参与护理的负担，并确定我们的LTFU和重新参与的特征患者此外，我们建立了我们的级联护理，以探索我们的中心与“90-90-90”目标的紧密程度。方法：我们从当地的电子数据库中提取了所有的艾滋病毒-在2012年至2018年期间至少与HIV诊所有一次接触的感染患者，不包括死亡和转移的患者。我们对LTFU的定义是基于最后一次接触后至少1年内没有任何就诊。访问患者重新参与被定义为那些首先被认为是LTFU患者谁随后是新的链接到HIV carry.Results：约8%的患者失去了随访期间的研究，每年不到2%的速度和14.1%的人重新参与护理。护理级联显示，2011年至2018年期间诊断的艾滋病毒感染者中，86.7%的患者继续接受护理，94.1%的患者接受cART治疗，95.6%的患者病毒学抑制。2011年以来诊断的感染者比2011年之前更高，如女性，来自外国的患者和病毒学控制较差的患者。在我们的队列中发现的留存率很高，符合90-90-90策略。然而，了解脱离和重新参与的决定因素对于加强最脆弱人口的护理保留至关重要。
Background: Despite the progress in HIV care, adherence to follow up remains critical. Disengagement impairs the benefit of HIV care and the increasing number of data that associates failed retention with worse outcomes has led public health institutions to consider retention in care as a new tool to fight against HIV pandemic.Objective: The aim of this retrospective, observational study was to estimate the burden of disengagement and reengagement in care in our HIV cohort and to identify the characteristics of our LTFU and reengaged patients. Moreover, we build our cascade of care to explore how closely our center aligned with the "90-90-90" targets.Methods: From the local electronic database we extracted all HIV-infected patients with at least one contact with HIV Clinic between 2012 and 2018 excluding deceased and transferred patients.Our definition of LTFU was based on the lack of any visit during at least 1 year after the last visit. Patients re-engaged were defined as those firstly considered as LTFU patients who subsequently were newly linked to HIV care.Results: About 8% of patients were lost to follow up during the period of study, with a rate of less than 2% per year and 14.1% of them were re-engaged in care. The cascade of care shows, among HIV cases diagnosed between 2011 and 2018, 86.7% patients retained in care, 94.1% of whom were on cART and 95.6% of whom were virologically suppressed.A higher attrition was found among infections diagnosed since 2011 than before 2011, such as women, patients coming from foreign countries and those with poor virological control.Conclusions: The retention rate found in our cohort is high and is in accordance with the 90-90-90 strategy. Nevertheless, understanding disengagement and re-engagement determinants is important to strengthen retention in care in the most fragile population.