Rapid scale-up of Antiretroviral therapy at primary care sites in Zambia - Feasibility and early outcomes
Rapid scale-up of Antiretroviral therapy at primary care sites in Zambia - Feasibility and early outcomes
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DOI：
10.1001/jama.296.7.782
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发表时间：
2006-08-16
影响因子：
120.7
通讯作者：
Sinkala, Moses
中科院分区：
文献类型：
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作者：
Stringer, Jeffrey S. A.;Zulu, Isaac;Sinkala, Moses
背景赞比亚卫生部扩大了卢萨卡初级保健诊所的人类免疫缺陷病毒/获得性免疫缺陷综合征(HIV/AIDS)护理和治疗服务，主要使用非内科临床医生。目的报告该计划的可行性和早期结果。2004年4月26日至2005年11月5日期间，对18家初级保健机构治疗的抗逆转录病毒初学者进行了设计、设置和患者公开队列评估。数据被实时输入电子患者跟踪系统。干预符合抗逆转录病毒治疗(ART)标准的患者根据赞比亚国家指南接受药物治疗。主要结果指标：存活率、方案失败率和CD4细胞反应。结果我们招募了21 755名成年人参加HIV护理，16 198人(75%)开始抗逆转录病毒治疗。在开始抗逆转录病毒治疗的人中，9864人(61%)是女性。在15866例世界卫生组织分期的患者中，11573例(73%)为III或IV期，基线结果为15336例患者的平均CD_4细胞计数为143个/亩L(123个/亩L)。在接受抗逆转录病毒治疗的1142名死亡患者中，1120名有可靠的死亡日期。在这些患者中，792人(71%)在开始治疗后90天内死亡(早期死亡率：每100人年26人)，328人(29%)在90天后死亡(90天后死亡率：每100人年5.0人)。在多变量分析中，死亡率与CD_4细胞计数在50个/亩L和199个/亩L之间(调整后的危险比，1.4；95%可信区间[CI]，1.0~2.0)，CD_4细胞计数<50个/亩的L(AHR，2.2；95%可信区间，1.5~3.1)，世卫组织III期疾病(AHR，1.8；95%CI，1.3~2.4)，世卫组织IV期疾病(AHR，2.9；95%CI，2.0-4.3)，低体重指数(
Context The Zambian Ministry of Health has scaled-up human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) care and treatment services at primary care clinics in Lusaka, using predominately nonphysician clinicians.Objective To report on the feasibility and early outcomes of the program.Design, Setting, and Patients Open cohort evaluation of antiretroviral-naive adults treated at 18 primary care facilities between April 26, 2004, and November 5, 2005. Data were entered in real time into an electronic patient tracking system.Intervention Those meeting criteria for antiretroviral therapy ( ART) received drugs according to Zambian national guidelines.Main Outcome Measures Survival, regimen failure rates, and CD4 cell response.Results We enrolled 21 755 adults into HIV care, and 16 198 (75%) started ART. Among those starting ART, 9864 (61%) were women. Of 15 866 patients with documented World Health Organization ( WHO) staging, 11 573 (73%) were stage III or IV, and the mean (SD) entry CD4 cell count among the 15 336 patients with a baseline result was 143/mu L (123/mu L). Of 1142 patients receiving ART who died, 1120 had a reliable date of death. Of these patients, 792 (71%) died within 90 days of starting therapy ( early mortality rate: 26 per 100 patient-years), and 328 (29%) died after 90 days (post-90-day mortality rate: 5.0 per 100 patient-years). In multivariable analysis, mortality was strongly associated with CD4 cell count between 50/mu L and 199/mu L ( adjusted hazard ratio [AHR], 1.4; 95% confidence interval [CI], 1.0-2.0), CD4 cell count less than 50/mu L ( AHR, 2.2; 95% CI, 1.5-3.1), WHO stage III disease ( AHR, 1.8; 95% CI, 1.3-2.4), WHO stage IV disease ( AHR, 2.9; 95% CI, 2.0-4.3), low body mass index (