Retention in Differentiated Care: Multiple Measures Analysis for a Decentralized HIV Care and Treatment Program in North Central Nigeria.
Retention in Differentiated Care: Multiple Measures Analysis for a Decentralized HIV Care and Treatment Program in North Central Nigeria.
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DOI：
10.4172/2155-6113.1000756
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发表时间：
2018-01-01
期刊：
影响因子：
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通讯作者：
Ware, Norma C
中科院分区：
文献类型：
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作者：
Agaba, Patricia A;Genberg, Becky L;Ware, Norma C
目的：差异化护理是指为满足资源匮乏地区艾滋病病毒感染者的不同需求而设计的灵活服务模式。去中心化就是这样一种服务模式。保留率是监测艾滋病毒治疗和护理计划成功与否的关键指标。我们使用多种措施来比较在尼日利亚中北部大型公共艾滋病毒治疗项目的“中心”（中央）和“辐射”（分散）地点接受艾滋病毒护理的患者队列的保留情况。 方法：这项回顾性队列研究利用了代表尼日利亚中北部高原州权力下放倡议中中央和分散护理水平的纵向项目数据。我们检查了患者级别（固定时间保留、失访[LTFU]）和就诊级别（护理差距、就诊一致性）措施的保留率。使用广义估计方程（GEE）的回归模型来估计权力下放对访问级别衡量指标的影响。使用 Cox 回归模型的生存方法检查患者水平的测量，并控制基线变量。 结果：在 15,650 名患者中，43% 在中心入组。中位护理时间为 3.1 年。与辐射患者相比，中心患者发生 LTFU 的可能性较小（调整后风险比 (AHR)=0.91，95% CI：0.85-0.97）。中心的就诊持续性较低（-4.5%，95% CI：-3.5，-5.5），那里也更有可能出现护理差距（调整后的比值比 = 1.95，95% CI：1.83-2.08）。结论：分散站点使用就诊级别的措施表现出更好的保留结果，而中心使用患者级别的措施实现了更好的保留结果。通过合并多种测量得出的保留估计显示出很大的差异，证实了测量策略对保留研究结果的影响。未来关于撒哈拉以南非洲地区艾滋病毒护理保留情况的研究将通过采取多种措施得到很好的帮助。
OBJECTIVE: Differentiated care refers collectively to flexible service models designed to meet the differing needs of HIV-infected persons in resource-scarce settings. Decentralization is one such service model. Retention is a key indicator for monitoring the success of HIV treatment and care programs. We used multiple measures to compare retention in a cohort of patients receiving HIV care at "hub" (central) and "spoke" (decentralized) sites in a large public HIV treatment program in north central Nigeria.METHODS: This retrospective cohort study utilized longitudinal program data representing central and decentralized levels of care in the Plateau State Decentralization Initiative, north central Nigeria. We examined retention with patient- level (retention at fixed times, loss-to-follow-up [LTFU]) and visit-level (gaps-in-care, visit constancy) measures. Regression models with generalized estimating equations (GEE) were used to estimate the effect of decentralization on visit-level measures. Patient-level measures were examined using survival methods with Cox regression models, controlling for baseline variables.RESULTS: Of 15,650 patients, 43% were enrolled at the hub. Median time in care was 3.1 years. Hub patients were less likely to be LTFU (adjusted hazard ratio (AHR)=0.91, 95% CI: 0.85-0.97), compared to spoke patients. Visit constancy was lower at the hub (-4.5%, 95% CI: -3.5, -5.5), where gaps in care were also more likely to occur (adjusted odds ratio=1.95, 95% CI: 1.83-2.08).CONCLUSION: Decentralized sites demonstrated better retention outcomes using visit-level measures, while the hub achieved better retention outcomes using patient-level measures. Retention estimates produced by incorporating multiple measures showed substantial variation, confirming the influence of measurement strategies on the results of retention research. Future studies of retention in HIV care in sub-Saharan Africa will be well-served by including multiple measures.