Brief Report: The Impact of Disease Stage on Early Gaps in ART in the "Treatment for All" Era-A Multisite Cohort Study.
Brief Report: The Impact of Disease Stage on Early Gaps in ART in the "Treatment for All" Era-A Multisite Cohort Study.
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简要报告：在“全民治疗”时代a多站点队列研究中，疾病阶段对ART早期差距的影响。
DOI：
10.1097/qai.0000000000002605
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发表时间：
2021-04-15
期刊：
影响因子：
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通讯作者：
META (Measuring Early Treatment Adherence) Team Investigators
中科院分区：
文献类型：
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作者：
Katz IT;Musinguzi N;Bell K;Cross A;Bwana MB;Amanyire G;Asiimwe S;Orrell C;Bangsberg DR;Haberer JE;META (Measuring Early Treatment Adherence) Team Investigators
“人人治疗”政策的采用增加了撒哈拉以南非洲抗逆转录病毒疗法的开始;然而，不明原因的早期损失继续发生。需要更多的信息来了解为什么在这个脆弱的护理阶段继续停止治疗。监测早期治疗依从性研究涉及一个前瞻性观察队列，在南非和乌干达的早期与晚期疾病中启动ART的个体。在基线、6个月和12个月时进行调查和HIV-1 RNA水平，并以电子方式监测依从性。该分析包括随访前6个月的非妊娠受试者;采用χ2、单变量和多变量模型比较各组的人口统计学和临床因素。在669名合格参与者中，91名（14%）显示ART使用的早期间隔≥30天（南非为22%，乌干达为6%），中位间隔时间分别为77天（四分位数范围：43-101）和87天（74，105）。尽管71例（78%）最终恢复治疗，但早期间隙仍与6个月时可检测到的病毒血症显著相关（P ≤ 0.01）。多变量建模，仅限于南非，发现中等教育和较高的身体健康评分保护早期差距[调整的比值比（aOR）0.4，95%置信区间（CI）：0.2至0.8和（aOR 0.93，95% CI：0.9至1.0）分别]。报告诊所“太远”的参与者早期差距的几率增加了一倍（aOR 2.2：95% CI：1.2至4.1）。抗逆转录病毒疗法的早期缺口持续存在，导致可检测到病毒血症的几率更高，特别是在南非。针对健康管理和获得护理的干预措施对于减少早期差距至关重要。
Adoption of “Treat All” policies has increased antiretroviral therapy (ART) initiation in sub-Saharan Africa; however, unexplained early losses continue to occur. More information is needed to understand why treatment discontinuation continues at this vulnerable stage in care. The Monitoring Early Treatment Adherence Study involved a prospective observational cohort of individuals initiating ART at early-stage versus late-stage disease in South Africa and Uganda. Surveys and HIV-1 RNA levels were performed at baseline, 6, and 12 months, with adherence monitored electronically. This analysis included nonpregnant participants in the first 6 months of follow-up; demographic and clinical factors were compared across groups with χ2, univariable, and multivariable models. Of 669 eligible participants, 91 (14%) showed early gaps of ≥30 days in ART use (22% in South Africa and 6% in Uganda) with the median time to gap of 77 days (interquartile range: 43–101) and 87 days (74, 105), respectively. Although 71 (78%) ultimately resumed care, having an early gap was still significantly associated with detectable viremia at 6 months (P ≤ 0.01). Multivariable modeling, restricted to South Africa, found secondary education and higher physical health score protected against early gaps [adjusted odds ratio (aOR) 0.4, 95% confidence interval (CI): 0.2 to 0.8 and (aOR 0.93, 95% CI: 0.9 to 1.0), respectively]. Participants reporting clinics as “too far” had double the odds of early gaps (aOR 2.2: 95% CI: 1.2 to 4.1). Early gaps in ART persist, resulting in higher odds of detectable viremia, particularly in South Africa. Interventions targeting health management and access to care are critical to reducing early gaps.