Effect of point-of-care early infant diagnosis on antiretroviral therapy initiation and retention of patients
Effect of point-of-care early infant diagnosis on antiretroviral therapy initiation and retention of patients
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DOI：
10.1097/qad.0000000000001846
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发表时间：
2018-07-17
期刊：
影响因子：
3.8
通讯作者：
Peter, Trevor F.
中科院分区：
文献类型：
--
作者：
Jani, Ilesh V.;Meggi, Bindiya;Peter, Trevor F.
目的：我们测量了护理点（POC）早期婴儿HIV检测对莫桑比克婴儿抗逆转录病毒治疗启动率和保留率的影响。设计：在16个初级卫生保健中心进行了一项随机分组试验，提供现场POC组（n = 8）或转诊实验室[护理标准（SOC）组; n = 8]婴儿HIV检测。方法：主要结果是在样本采集后60天内开始抗逆转录病毒治疗的HIV阳性婴儿的比例，以及在90天随访时开始抗逆转录病毒治疗并继续接受护理的HIV阳性婴儿的比例。艾滋病毒阳性婴儿在样本采集后60天内开始抗逆转录病毒治疗的比例为89.7% POC组为157/175，SOC组为12.8%（13/102）[相对危险度（RR）（（adj））7.34; P < 0.001]。接受抗逆转录病毒治疗的HIV阳性婴儿在90天随访时继续接受护理的比例，POC组为61.6%（101/164），SOC组为42.9%（21/49）[RR（adj）1.40; P < 0.027]。从样本采集到开始抗逆转录病毒治疗的中位时间，POC组小于1天（四分位距：0-1），SOC组为127天（44-154; P < 0.001）。结论：POC婴儿HIV检测使诊所能够更快地诊断和治疗HIV感染的婴儿。这减少了治疗前失访的机会，使更多的婴儿能够获得检测结果并开始抗逆转录病毒治疗。更快的艾滋病毒诊断和抗逆转录病毒治疗的好处也可能改善早期护理的保留。版权所有（C）2018威科医疗集团All rights reserved.
Objective: We measured the effect of point-of-care (POC) early infant HIV testing on antiretroviral therapy initiation rates and retention in care among infants in Mozambique.Design: A cluster-randomized trial was conducted in 16 primary healthcare centres providing either on-site POC arm (n = 8) or referred laboratory [standard-of-care (SOC) arm; n = 8] infant HIV testing.Methods: The primary outcomes were the proportion of HIV-positive infants initiating antiretroviral therapy within 60 days of sample collection, and the proportion of HIVpositive infants who initiated antiretroviral therapy that were retained in care at 90 days of follow-up.Results: The proportion of HIV-positive infants initiating antiretroviral therapy within 60 days of sample collection was 89.7% (157 of 175) for the POC arm and 12.8% (13 of 102) for the SOC arm [relative risk (RR)((adj)) 7.34; P < 0.001]. The proportion of HIV-positive infants who initiated antiretroviral therapy that were retained in care at 90 days of follow-up was 61.6% (101 of 164) for the POC arm and 42.9% (21 of 49) for the SOC arm [RR(adj) 1.40; P < 0.027]. The median time from sample collection to antiretroviral therapy initiation was less than 1 day (interquartile range: 0-1) for the POC arm and 127 days (44-154; P < 0.001) for the SOC arm.Conclusion: POC infant HIV testing enabled clinics to more rapidly diagnose and provide treatment to HIV-infected infants. This reduced opportunities for pretreatment loss to follow-up and enabled a larger proportion of infants to receive test results and initiate antiretroviral therapy. The benefits of faster HIV diagnosis and antiretroviral treatment may also improve early retention in care. Copyright (C) 2018 Wolters Kluwer Health, Inc. All rights reserved.