Attrition and Opportunities Along the HIV Care Continuum: Findings From a Population-Based Sample, North West Province, South Africa.
Attrition and Opportunities Along the HIV Care Continuum: Findings From a Population-Based Sample, North West Province, South Africa.
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艾滋病毒护理连续体中的人员流失和机会：来自南非西北省人口样本的调查结果。
DOI：
10.1097/qai.0000000000001026
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发表时间：
2016-09-01
期刊：
影响因子：
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通讯作者：
Barnhart S
中科院分区：
文献类型：
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作者：
Lippman SA;Shade SB;El Ayadi AM;Gilvydis JM;Grignon JS;Liegler T;Morris J;Naidoo E;Prach LM;Puren A;Barnhart S
沿艾滋病毒护理连续体的自然减员减缓了在缓解南非艾滋病毒流行方面取得的成果。了解人群在艾滋病毒识别、关联、保留护理和病毒抑制方面的差距对于目标规划至关重要。2014年1月至3月，我们在西北省的两个街道进行了以人群为基础的家庭调查、HIV快速检测、护理点CD4检测以及干血点病毒载量(DBS)的多阶段整群抽样。我们使用加权和缺失数据的多重归因来估计HIV流行率、未诊断感染、护理中的关联和保留、用药依从性和病毒抑制。我们抽样调查了1044名年龄在18-49岁之间的受访者。男性HIV感染率为20.0%(95%CI：13.7-26.2)，女性为26.7%(95%CI：22.1-31.4)。在艾滋病毒阳性者中，48.4%的男性和75.7%的女性知道自己的血清状态；44.0%的男性和74.8%的女性报告曾与艾滋病毒护理联系在一起；33.1%的男性和58.4%的女性仍在接受护理；21.6%的男性和50.0%的女性DBS病毒载量为5000拷贝/毫升。在那些已经与CARE相关的患者中，81.7%接受ART治疗的患者和56.0%未接受ART治疗的患者保留在CARE中，51.8%目前保留在CARE中的ART患者的病毒载量为5000份/毫升。尽管南非扩大了治疗，但艾滋病毒护理连续过程中的自然减员正在减缓预防进展。迫切需要改进检测，特别是在男性中。报告的连锁和滞留对于那些接受ART的人来说是合理的，然而未能实现病毒抑制令人担忧。
Attrition along the HIV care continuum slows gains in mitigating the South African HIV epidemic. Understanding population-level gaps in HIV identification, linkage, retention in care and viral suppression is critical to target programming. We conducted a population-based household survey, HIV rapid testing, point-of-care CD4 testing, and viral load measurement from dried blood spots (DBS) using multi-stage cluster sampling in two sub-districts of North West Province from January–March, 2014. We used weighting and multiple imputation of missing data to estimate HIV prevalence, undiagnosed infection, linkage and retention in care, medication adherence, and viral suppression. We sampled 1044 respondents ages 18–49. HIV prevalence was 20.0% (95% CI: 13.7–26.2) for men and 26.7% (95%CI: 22.1–31.4) for women. Among those HIV-positive, 48.4% of men and 75.7% of women were aware of their serostatus; 44.0% of men and 74.8% of women reported ever linking to HIV care; 33.1% of men and 58.4% of women were retained in care; and 21.6% of men and 50.0% of women had DBS viral loads < 5000 copies/mL. Among those already linked to care, 81.7% on ART and 56.0% of those not on ART were retained in care and 51.8% currently retained in care on ART had viral loads < 5000 copies/mL. Despite expanded treatment in South Africa, attrition along the continuum of HIV care is slowing prevention progress. Improved detection is critically needed, particularly among men. Reported linkage and retention is reasonable for those on ART, however failure to achieve viral suppression is worrisome.