Mitigating the effects of COVID-19 on HIV treatment and care in Lusaka, Zambia: a before-after cohort study using mixed effects regression.
Mitigating the effects of COVID-19 on HIV treatment and care in Lusaka, Zambia: a before-after cohort study using mixed effects regression.
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DOI：
10.1136/bmjgh-2021-007312
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发表时间：
2022-01
影响因子：
8.1
通讯作者：
Herce ME
中科院分区：
文献类型：
--
作者：
Pry JM;Sikombe K;Mody A;Iyer S;Mutale J;Vlahakis N;Savory T;Wa Mwanza M;Mweebo K;Mwila A;Mwale C;Mukumbwa-Mwenechanya M;Kerkhoff AD;Sikazwe I;Bolton Moore C;Mwamba D;Geng EH;Herce ME
在赞比亚于2020年3月18日确诊首例COVID-19病例后，赞比亚卫生部立即发布了针对艾滋病毒护理的COVID-19缓解指南。赞比亚传染病研究中心通过以下方式实施了卫生部的指导：1)将抗逆转录病毒治疗（ART）的补充时间延长至6个月的分配时间（6MMD）； 2)对艾滋病毒感染者进行任务转移沟通和动员，以便尽早收集下一次抗逆转录病毒治疗。我们评估了指南实施前后3个月COVID-19缓解指南对艾滋病毒护理的影响。我们审查了在赞比亚卢萨卡省59个艾滋病毒护理机构中，在2020年1月1日至6月30日期间就诊≥1次的艾滋病毒感染者的国家艾滋病毒医疗记录中的所有抗逆转录病毒药物就诊数据。我们使用混合效应泊松回归进行了前后评估，以检查预测因子和早期临床返回的边际概率（下次预约前7天访问药房），延迟访问的比例（下次预约晚7天访问药房）和接受6MMD ART补充的概率。共有101 371人（64%为女性，中位年龄39岁）就诊130 486次。我们观察到，与实施指南后相比，实施指南前早期回归的调整患病率显著增加（4.63;95% CI 4.45至4.82）。6MMD的周平均采收率从之前的47.9% （95% CI 46.6% - 49.2%）增加到指南实施后的73.4% （95% CI 72.0% - 74.9%）。实施指导前（18.8%,95% ci17.2% ~ 20.2%）延迟就诊比例显著高于实施指导后（15.1%,95% ci13.8% ~ 16.4%）。及时发布和实施COVID-19缓解指南，包括任务转移的患者沟通和动员，以及600万美元的治疗，大大增加了抗逆转录病毒治疗诊所的早期回复率，有可能减少全球突发公共卫生事件期间艾滋病毒治疗的中断。
The Zambian Ministry of Health (MoH) issued COVID-19 mitigation guidance for HIV care immediately after the first COVID-19 case was confirmed in Zambia on 18 March 2020. The Centre for Infectious Disease Research in Zambia implemented MoH guidance by: 1) extending antiretroviral therapy (ART) refill duration to 6 multi-month dispensation (6MMD) and 2) task-shifting communication and mobilisation of those in HIV care to collect their next ART refill early. We assessed the impact of COVID-19 mitigation guidance on HIV care 3 months before and after guidance implementation. We reviewed all ART pharmacy visit data in the national HIV medical record for PLHIV in care having ≥1 visit between 1 January—30 June 2020 at 59 HIV care facilities in Lusaka Province, Zambia. We undertook a before–after evaluation using mixed-effects Poisson regression to examine predictors and marginal probability of early clinic return (pharmacy visit >7 days before next appointment), proportion of late visit (>7 days late for next appointment) and probability of receiving a 6MMD ART refill. A total of 101 371 individuals (64% female, median age 39) with 130 486 pharmacy visits were included in the analysis. We observed a significant increase in the adjusted prevalence ratio (4.63; 95% CI 4.45 to 4.82) of early return before compared with after guidance implementation. Receipt of 6MMD increased from a weekly mean of 47.9% (95% CI 46.6% to 49.2%) before to 73.4% (95% CI 72.0% to 74.9%) after guidance implementation. The proportion of late visits (8–89 days late) was significantly higher before (18.8%, 95% CI17.2%to20.2%) compared with after (15.1%, 95% CI13.8%to16.4%) guidance implementation. Timely issuance and implementation of COVID-19 mitigation guidance involving task-shifted patient communication and mobilisation alongside 6MMD significantly increased early return to ART clinic, potentially reducing interruptions in HIV care during a global public health emergency.
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DOI：
10.1097/qai.0000000000002554
发表时间：
2021-03-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Beres LK;Schwartz S;Simbeza S;McGready J;Eshun-Wilson I;Mwamba C;Sikombe K;Topp SM;Somwe P;Mody A;Mukamba N;Ehrenkranz PD;Padian N;Pry J;Moore CB;Holmes CB;Sikazwe I;Denison JA;Geng E
通讯作者：
Geng E
影响因子：
4.7
作者：
Dean, Andrea Lach;Makin, Jennifer D.;Forsyth, Brian W. C.
通讯作者：
Forsyth, Brian W. C.
影响因子：
16.1
作者：
Jewell, Britta L.;Mudimu, Edinah;Kelly, Sherrie L.
通讯作者：
Kelly, Sherrie L.
影响因子：
3.5
作者：
Porter, Gina;Hampshire, Kate;Milner, James
通讯作者：
Milner, James
影响因子：
1.8
作者：
Sisay, Solomon;Erku, Woldaregay;Woldeyohannes, Desalegn
通讯作者：
Woldeyohannes, Desalegn