Diminishing availability of publicly funded slots for antiretroviral initiation among HIV-infected ART-eligible patients in Uganda.
Diminishing availability of publicly funded slots for antiretroviral initiation among HIV-infected ART-eligible patients in Uganda.
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DOI：
10.1371/journal.pone.0014098
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发表时间：
2010-11-24
期刊：
影响因子：
3.7
通讯作者：
Bangsberg DR
中科院分区：
文献类型：
--
作者：
Geng EH;Bwana MB;Kabakyenga J;Muyindike W;Emenyonu NI;Musinguzi N;Mugyenyi P;Martin JN;Bangsberg DR
在全球扩大对非洲艾滋病毒感染者的抗逆转录病毒治疗（ART）方面，平线供资的影响尚未得到很好的描述。2009年4月1日至2010年5月14日期间，我们在乌干达姆巴拉拉一个典型的扩大抗逆转录病毒治疗规模的诊所对符合条件的患者和开始抗逆转录病毒治疗的患者进行了评估。四个利益相关者赞助了治疗——两个PEPFAR实施组织、乌干达卫生部全球基金（MOH-GF）和一个名为家庭治疗基金（FTF）的私人基金会。我们评估了符合条件的患者人数、开始抗逆转录病毒治疗的人数的时间趋势，并按月和四分位数的时间列出了支持开始抗逆转录病毒治疗的利益相关者的分布。我们使用生存分析来评估在日历时间内ART起始率的变化。在14个月的研究期间，共有1309名有资格接受抗逆转录病毒治疗的患者就诊，其中819人开始接受抗逆转录病毒治疗。每月接受ART治疗的患者中位数为88例（IQR: 74 - 115）。按日历时间的四分位数计算，PEPFAR和MOH分别资助了290、192、180和49个ART启动，而FTF分别资助了1、2、1和104个患者。到2010年5月（观察的最后一个日历月），FTF赞助了88%的抗逆转录病毒疗法启动。在多变量分析中，与第一个四分位数相比，第3个四分位数（HR = 0.58, 95% 0.45-0.74）和第4个四分位数（HR = 0.49, 95% CI: 0.36-0.65）与ART起始延迟相关。在多国捐助者为抗逆转录病毒治疗项目提供的资金持平期间，公共项目（即总统防治艾滋病紧急救援计划和卫生部基金）启动的抗逆转录病毒治疗数量减少，启动抗逆转录病毒治疗的时间推迟，这在乌干达的一个大规模抗逆转录病毒治疗原型诊所中很明显。
The impact of flat-line funding in the global scale up of antiretroviral therapy (ART) for HIV-infected patients in Africa has not yet been well described. We evaluated ART-eligible patients and patients starting ART at a prototypical scale up ART clinic in Mbarara, Uganda between April 1, 2009 and May 14, 2010 where four stakeholders sponsor treatment – two PEPFAR implementing organizations, the Ugandan Ministry of Health – Global Fund (MOH-GF) and a private foundation named the Family Treatment Fund (FTF). We assessed temporal trends in the number of eligible patients, the number starting ART and tabulated the distribution of the stakeholders supporting ART initiation by month and quartile of time during this interval. We used survival analyses to assess changes in the rate of ART initiation over calendar time. A total of 1309 patients who were eligible for ART made visits over the 14 month period of the study and of these 819 started ART. The median number of ART eligible patients each month was 88 (IQR: 74 to 115). By quartile of calendar time, PEPFAR and MOH sponsored 290, 192, 180, and 49 ART initiations whereas the FTF started 1, 2, 1 and 104 patients respectively. By May of 2010 (the last calendar month of observation) FTF sponsored 88% of all ART initiations. Becoming eligible for ART in the 3rd (HR = 0.58, 95% 0.45–0.74) and 4th quartiles (HR = 0.49, 95% CI: 0.36–0.65) was associated with delay in ART initiation compared to the first quartile in multivariable analyses. During a period of flat line funding from multinational donors for ART programs, reductions in the number of ART initiations by public programs (i.e., PEPFAR and MOH-GF) and delays in ART initiation became apparent at the a large prototypical scale-up ART clinic in Uganda.
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