Mortality and loss to follow-up among HAART initiators in rural South Africa
Mortality and loss to follow-up among HAART initiators in rural South Africa
复制标题
DOI：
10.1016/j.trstmh.2008.10.001
复制
发表时间：
2009-06-01
影响因子：
2.2
通讯作者：
Pronyk, Paul
中科院分区：
文献类型：
--
作者：
MacPherson, Peter;Moshabela, Mosa;Pronyk, Paul
一项回顾性队列研究的死亡率和潜在的死亡预测因素进行了在公共部门的患者启动高效抗逆转录病毒治疗（HAART）2005年10月至2007年9月在农村，资源不足的地区，南非。目的是确定死亡对队列退出的相对贡献，以及HAART启动者死亡的原因和预测因素。一项社区外展计划追踪了未参加者。被归类为在家中死亡的患者接受了口头尸检（通过采访家庭成员）和病例档案审查，而那些在医院死亡的患者则接受了病例档案审查，以确定可能的死亡原因。在24个月时，1131例（83.6%）患者继续在该项目中接受治疗，124例（9.2%）患者死亡，63例（4.7%）患者转出，35例（2.6%）患者失访。最常见的死因是结核病（44.3%）和泌尿系统疾病（24.5%）。死亡是退出队列的主要原因。随着农村高效抗逆转录病毒治疗方案取得经验，死亡率可能会下降。这些结果提醒人们注意，需要早期诊断艾滋病毒，增加获得高效抗逆转录病毒治疗服务的机会，尽早开始治疗，并定期筛查和积极管理机会性感染，特别是结核病。(C)2008年皇家热带医学和卫生学会。由爱思唯尔有限公司出版。保留所有权利。
A retrospective cohort study of mortality rates and potential predictors of death was conducted in public-sector patients initiating highly active antiretroviral therapy (HAART) between October 2005 and September 2007 in a rural, under-resourced region of South Africa. The aims were to determine the relative contribution of death to cohort exit and the causes and predictors of mortality among HAART initiators. A community outreach programme traced non-attenders. Patients categorised as dying at home underwent a verbal autopsy (by interviewing family members) and case-file review, and those dying in hospital a case-file review, to determine the probable cause of death. At 24 months 1131 (83.6%) patients were retained on treatment in the programme, 124 (9.2%) had died, 63 (4.7%) had transferred out, and 35 (2.6%) were lost to follow-up. The most common causes of death were tuberculosis (44.3%) and diarrhoeal diseases (24.5%). Death was the major reason for cohort exit. As experience is gained with rural HAART programmes mortality rates may decrease. These results draw attention to the need for early HIV diagnosis, increased access to HAART services with earlier treatment initiation, and routine screening and aggressive management of opportunistic infections, particularly tuberculosis. (C) 2008 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.