Contrasting predictors of poor antiretroviral therapy outcomes in two South African HIV programmes: a cohort study.
Contrasting predictors of poor antiretroviral therapy outcomes in two South African HIV programmes: a cohort study.
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DOI：
10.1186/1471-2458-10-430
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发表时间：
2010-07-22
影响因子：
4.5
通讯作者：
Grant AD
中科院分区：
文献类型：
--
作者：
Dahab M;Charalambous S;Karstaedt AS;Fielding KL;Hamilton R;La Grange L;Churchyard GJ;Grant AD
许多国家的抗逆转录病毒疗法（ART）方案鼓励提供者在开始ART之前确定和解决与不良治疗结果相关的基线因素，包括可改变的依从性相关行为。为了帮助解决这一证据缺口，这项观察性队列研究检查了南非两个ART项目中可能预测不良治疗结局的基线因素，特别关注依从性的决定因素。开始ART治疗的初治患者从社区和工作场所ART计划中招募。使用逻辑回归评估与不良治疗结果相关的潜在基线预测因素（定义为病毒载量> 400拷贝/ml或在6个月内停止治疗）。使用分层框架组织暴露变量进行回归分析。社区中38/227（17%）的参与者治疗效果较差，而工作场所中47/117（40%）的参与者治疗效果较差。在社区中，预测更糟糕结果的因素包括：每周饮酒超过20个单位，既往没有慢性药物治疗经验，以及在过去一年中咨询过传统治疗师（调整后比值比[aOR] 15.36，95%CI 3.22-73.27; aOR 2.30，95%CI 1.00-5.30; aOR 2.27，95%CI 1.00-5.19）。男性和认识接受ART的人与更好的结局相关（aOR 0.25，95%CI 0.09-0.74; aOR 0.44，95%CI 0.19-1.01）。在工作场所，治疗效果差的预测因素包括不确定ART对健康的影响和传统治疗师治疗HIV的能力（aOR 7.53，95%CI 2.02-27.98; aOR 4.40，95%CI 1.41-13.75）。较长的ART前等待时间（2-12周与<2周相比）预测更好的治疗结果（aOR 0.13，95% CI 0.03-0.56）。治疗效果不佳的基线预测因素在很大程度上是每个方案所独有的，可能反映了不同的人群和艾滋病毒护理途径。在工作场所，积极推广艾滋病毒检测可能已将抗逆转录病毒疗法扩展到那些在没有提供者发起的情况下不会自发寻求护理的个人。由于提供者发起的测试使ART可用于寻求护理的动机较低的个人，患者可能需要额外的依从性支持，特别是解决ART健康益处的不确定性。
Many national antiretroviral therapy (ART) programmes encourage providers to identify and address baseline factors associated with poor treatment outcomes, including modifiable adherence-related behaviours, before initiating ART. However, evidence on such predictors is scarce, and providers judgement may often be inaccurate. To help address this evidence gap, this observational cohort study examined baseline factors potentially predictive of poor treatment outcomes in two ART programmes in South Africa, with a particular focus on determinants of adherence. Treatment-naïve patients starting ART were enrolled from a community and a workplace ART programme. Potential baseline predictors associated with poor treatment outcomes (defined as viral load > 400 copies/ml or having discontinued treatment by six months) were assessed using logistic regression. Exposure variables were organised for regression analysis using a hierarchical framework. 38/227 (17%) of participants in the community had poor treatment outcomes compared to 47/117 (40%) in the workplace. In the community, predictors of worse outcomes included: drinking more than 20 units of alcohol per week, having no prior experience of chronic medications, and consulting a traditional healer in the past year (adjusted odds ratio [aOR] 15.36, 95% CI 3.22-73.27; aOR 2.30, 95%CI 1.00-5.30; aOR 2.27, 95% CI 1.00-5.19 respectively). Being male and knowing someone on ART were associated with better outcomes (aOR 0.25, 95%CI 0.09-0.74; aOR 0.44, 95%CI 0.19-1.01 respectively). In the workplace, predictors of poor treatment outcomes included being uncertain about the health effects of ART and a traditional healer's ability to treat HIV (aOR 7.53, 95%CI 2.02-27.98; aOR 4.40, 95%CI 1.41-13.75 respectively). Longer pre-ART waiting time (2-12 weeks compared to <2 weeks) predicted better treatment outcomes (aOR 0.13, 95% CI 0.03-0.56). Baseline predictors of poor treatment outcomes were largely unique to each programme, likely reflecting different populations and pathways to HIV care. In the workplace, active promotion of HIV testing may have extended ART to individuals who, without provider initiation, would not have spontaneously sought care. As provider-initiated testing makes ART available to individuals less motivated to seek care, patients may need additional adherence support, especially addressing uncertainty about the health benefits of ART.
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影响因子：
15.8
作者：
Mills EJ;Nachega JB;Bangsberg DR;Singh S;Rachlis B;Wu P;Wilson K;Buchan I;Gill CJ;Cooper C
通讯作者：
Cooper C
影响因子：
3.8
作者：
Bangsberg, DR;Perry, S;Moss, A
通讯作者：
Moss, A
影响因子：
1.4
作者：
Aboubacrine, S. Ag;Niamba, P.;Rashed, S.
通讯作者：
Rashed, S.
DOI：
10.1097/00126334-200408010-00011
发表时间：
2004-08-01
影响因子：
3.6
作者：
Hofer, CB;Schechter, M;Harrison, LH
通讯作者：
Harrison, LH
影响因子：
1.5
作者：
Marazzi, Maria Cristina;Liotta, Giuseppe;Palombi, Leonardo
通讯作者：
Palombi, Leonardo