Loss to care and death before antiretroviral therapy in Durban, South Africa.
Loss to care and death before antiretroviral therapy in Durban, South Africa.
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DOI：
10.1097/qai.0b013e3181a44ef2
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发表时间：
2009-06-01
期刊：
影响因子：
--
通讯作者：
Freedberg KA
中科院分区：
文献类型：
--
作者：
Bassett IV;Wang B;Chetty S;Mazibuko M;Bearnot B;Giddy J;Lu Z;Losina E;Walensky RP;Freedberg KA
在南非德班，在开始抗逆转录病毒疗法(ART)之前，检查符合抗逆转录病毒疗法(ART)标准的艾滋病毒感染患者的护理损失和死亡率。回顾性队列研究。我们回顾了2006年7月至12月在一家城市艾滋病毒诊所每月收费的符合抗逆转录病毒治疗资格的成年人(≥18岁)的数据。抗逆转录病毒治疗的资格是基于CD_4计数、≤每微升200个细胞或临床标准以及心理社会评估。没有开始抗逆转录病毒治疗并在3个月内走失的患者被打电话。使用Logistic回归分析评估损失与护理的相关性。在研究期间，501名患者登记参加抗逆转录病毒治疗培训。从最初的CD_4计数到第一次抗逆转录病毒治疗培训的平均时间为3.6月(四分位数范围2.3−3.9月)。在3个月的随访中，408名患者(81.4%)在接受ART治疗，11名(2.2%)患者在接受治疗但没有开始接受ART。82名符合抗逆转录病毒治疗条件的患者(16.4%)在抗逆转录病毒治疗开始前丢失。其中28人(34.1%)死亡；三分之二的死亡发生在第一次ART培训之前或之后2个月内。尽管多次尝试，仍有32名患者(39%)无法通过电话联系到。基线CD4细胞计数较低(≤100Cells/μL)和失业独立地与丢失相关。在南非德班的一家艾滋病诊所，在开始抗逆转录病毒治疗之前，经常发生因护理而死亡的情况。这种从CD4计数到抗逆转录病毒治疗训练的延迟，即使是在CD4计数最低的人中，也突显了干预措施的必要性，这些干预措施改善了与护理的联系，并优先为那些基线CD4计数较低的人启动ART。
To examine the loss to care and mortality rates before starting antiretroviral therapy (ART) among ART eligible HIV-infected patients in Durban, South Africa. Retrospective cohort study. We reviewed data from ART eligible adults (≥18 years) at an urban HIV clinic that charges a monthly fee from July to December 2006. ART eligibility was based on CD4 count ≤200 cells per microliter or clinical criteria and a psychosocial assessment. Patients who did not start ART and were lost within 3 months were phoned. Correlates of loss to care were evaluated using logistic regression. During the study period, 501 patients registered for ART training. Mean time from initial CD4 count to first ART training was 3.6 months (interquartile range 2.3−3.9 months). Four hundred eight patients (81.4%) were in care and on ART at 3-month follow-up, and 11 (2.2%) were in care but had not initiated ART. Eighty-two ART eligible patients (16.4%) were lost before ART initiation. Of these, 28 (34.1%) had died; two thirds of deaths occurred before or within 2 months after the first ART training. Despite multiple attempts, 32 patients (39%) were unreachable by phone. Lower baseline CD4 counts (≤100 cells/μL) and unemployment were independently associated with being lost. Loss to care and death occur frequently before starting ART at an HIV clinic in Durban, South Africa. This delay from CD4 count to ART training, even among those with the lowest CD4 counts, highlights the need for interventions that improve linkage to care and prioritize ART initiation for those with low baseline CD4 counts.
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