Is forced migration a barrier to treatment success? Similar HIV treatment outcomes among refugees and a surrounding host community in Kuala Lumpur, Malaysia.
Is forced migration a barrier to treatment success? Similar HIV treatment outcomes among refugees and a surrounding host community in Kuala Lumpur, Malaysia.
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DOI：
10.1007/s10461-013-0494-0
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发表时间：
2014-02
影响因子：
4.4
通讯作者：
Ross, David A.
中科院分区：
文献类型：
--
作者：
Mendelsohn, Joshua B.;Schilperoord, Marian;Spiegel, Paul;Balasundaram, Susheela;Radhakrishnan, Anuradha;Lee, Christopher K. C.;Larke, Natasha;Grant, Alison D.;Sondorp, Egbert;Ross, David A.
由于缺乏对城市环境中获得高效抗逆转录病毒治疗（HAART）的难民和收容社区的研究，我们的目标是比较在马来西亚吉隆坡公共诊所就诊的客户的依从性和病毒学结果。在成年客户（≥18岁）中进行了横断面调查。数据来源包括一个结构化的问卷调查，测量自我报告的遵守，一个基于药房的措施，在过去24个月的HAART处方笔芯，和艾滋病毒载量。主要结局为未抑制的病毒载量（≥40拷贝/mL）。在153名难民和148名收容社区客户的抽样调查中，（中位年龄35岁[四分位距，IQR 31，39] vs 40岁[IQR 35，48]，p < 0.001），更可能是女性（36 vs 21%，p = 0.004），并且接受HAART的时间更短（61 [IQR 35，108] vs 153周[IQR 63，298]; p < 0.001）。在所有客户中，难民和接待客户的相似比例<95%坚持药房续药（26 vs 34%，p = 0.15）。当仅限于接受治疗≥25周的客户时，各组中病毒学未受到抑制的比例相似（难民19% vs接待客户16%，p = 0.54）。难民身份与预后无独立相关性（校正比值比，aOR = 1.28，95%CI 0.52，3.14）.总体而言，病毒载量未受抑制和坚持治疗不佳的难民和收容社区客户的比例相似，这支持了这样一种观点，即长期庇护情况下的难民能够维持良好的治疗结果，应明确纳入收容国的艾滋病毒战略计划，以便根据国家高效抗逆转录病毒疗法准则扩大获得治疗的机会。本文的在线版本（doi：10.1007/s10461-013-0494-0）包含补充材料，可供授权用户使用。
In response to an absence of studies among refugees and host communities accessing highly active antiretroviral therapy (HAART) in urban settings, our objective was to compare adherence and virological outcomes among clients attending a public clinic in Kuala Lumpur, Malaysia. A cross-sectional survey was conducted among adult clients (≥18 years). Data sources included a structured questionnaire that measured self-reported adherence, a pharmacy-based measure of HAART prescription refills over the previous 24 months, and HIV viral loads. The primary outcome was unsuppressed viral load (≥40 copies/mL). Among a sample of 153 refugees and 148 host community clients, refugees were younger (median age 35 [interquartile range, IQR 31, 39] vs 40 years [IQR 35, 48], p < 0.001), more likely to be female (36 vs 21 %, p = 0.004), and to have been on HAART for less time (61 [IQR 35, 108] vs 153 weeks [IQR 63, 298]; p < 0.001). Among all clients, similar proportions of refugee and host clients were <95 % adherent to pharmacy refills (26 vs 34 %, p = 0.15). When restricting to clients on treatment for ≥25 weeks, similar proportions from each group were not virologically suppressed (19 % of refugees vs 16 % of host clients, p = 0.54). Refugee status was not independently associated with the outcome (adjusted odds ratio, aOR = 1.28, 95 % CI 0.52, 3.14). Overall, the proportions of refugee and host community clients with unsuppressed viral loads and sub-optimal adherence were similar, supporting the idea that refugees in protracted asylum situations are able to sustain good treatment outcomes and should explicitly be included in the HIV strategic plans of host countries with a view to expanding access in accordance with national guidelines for HAART. The online version of this article (doi:10.1007/s10461-013-0494-0) contains supplementary material, which is available to authorized users.
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DOI：
10.1111/j.1365-3156.2009.02290.x
发表时间：
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期刊：
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