Effect of the "universal test and treat" policy on the characteristics of persons registering for HIV care and initiating antiretroviral therapy in Uganda.
Effect of the "universal test and treat" policy on the characteristics of persons registering for HIV care and initiating antiretroviral therapy in Uganda.
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DOI：
10.3389/fpubh.2023.1187274
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发表时间：
2023
影响因子：
5.2
通讯作者：
Ruzagira, Eugene
中科院分区：
文献类型：
--
作者：
Mugenyi, Levicatus;Hansen, Christian H. H.;Mayaud, Philippe;Seeley, Janet;Newton, Robert;Nanfuka, Mastula;Abaasa, Andrew;Mugisha, Kenneth;Etukoit, Michael;Kaleebu, Pontiano;Ruzagira, Eugene
我们研究了通用测试和治疗（UTT）政策对艾滋病毒感染者（PLHIV）在艾滋病毒护理登记和开始抗逆转录病毒治疗（ART）的特点的影响，使用来自艾滋病支持组织（TASO）的11个全国代表性诊所的数据。我们创建了两个回顾性PLHIV队列：UTT前（2004-2016），其中ART启动以CD 4细胞计数为条件，UTT（2017-2022），其中ART启动不考虑世界卫生组织（WHO）临床分期或CD 4细胞计数。我们使用了两个样本的比例检验和Wilcoxon秩和检验来比较队列之间的比例和中位数。共有244 693名艾滋病毒感染者在诊所登记[UTT前，210 251人（85.9%）; UTT，34 442人（14.1%）]。与UTT前队列相比，UTT队列中男性（p < 0.001）、年龄18-29岁（p <0.001）、年龄>69岁、从未结婚（p <0.001）、在接受艾滋病毒护理和抗逆转录病毒治疗时受过小学（p < 0.001）和小学后（p < 0.001）教育的艾滋病毒感染者比例较高。总体而言，97.9%的UTT艾滋病毒感染者开始接受抗逆转录病毒治疗，而UTT前为45.2%。从入组HIV护理到开始ART的中位时间从UTT前的301 [四分位距（IQR）：58-878]降至UTT下的0（IQR：0-0）。ART启动时的中位CD 4计数从UTT前的254个细胞/μ L增加到UTT下的482个细胞/μL（p < 0.001）。与UTT前队列相比，UTT队列在ART启动时CD 4计数>500个细胞/μL（47.3% vs. 13.2%，p < 0.001）和WHO 1期（31.7% vs. 4.5%，p < 0.001）的PLHIV比例较高。乌干达通过的UTT政策成功地使以前未接触到的个人，如男子、年轻人和老年人，以及艾滋病毒感染程度较低的人参加。未来的研究将调查UTT对长期结果的影响，如保留护理，HIV病毒抑制，发病率和死亡率。
We examined the effect of the Universal Test and Treat (UTT) policy on the characteristics of people living with HIV (PLHIV) at enrolment in HIV care and initiation of antiretroviral therapy (ART) in Uganda using data from 11 nationally representative clinics of The AIDS Support Organisation (TASO). We created two retrospective PLHIV cohorts: pre-UTT (2004–2016), where ART initiation was conditional on CD4 cell count and UTT (2017–2022), where ART was initiated regardless of World Health Organisation (WHO) clinical stage or CD4 cell count. We used a two-sample test of proportions and Wilcoxon rank-sum test to compare proportions and medians, respectively, between the cohorts. A total of 244,693 PLHIV were enrolled at the clinics [pre-UTT, 210,251 (85.9%); UTT, 34,442 (14.1%)]. Compared to the pre-UTT cohort, the UTT cohort had higher proportions of PLHIV that were male (p < 0.001), aged 18–29 years (p < 0.001), aged >69 years, never married (p < 0.001), and educated to primary (p < 0.001) and post-primary (p < 0.001) school level at enrolment in HIV care and ART initiation. Overall, 97.9% of UTT PLHIV initiated ART compared to 45.2% under pre-UTT. The median time from enrolment in HIV care to ART initiation decreased from 301 [interquartile range (IQR): 58–878] pre-UTT to 0 (IQR: 0–0) under UTT. The median CD4 count at ART initiation increased from 254 cells/μL pre-UTT to 482 cells/μL under UTT (p < 0.001). Compared to the pre-UTT cohort, the UTT cohort had higher proportions of PLHIV with a CD4 count >500 cells/μL (47.3% vs. 13.2%, p < 0.001) and WHO stage 1 (31.7% vs. 4.5%, p < 0.001) at ART initiation. Adoption of the UTT policy in Uganda was successful in enrolling previously unreached individuals, such as men and younger and older adults, as well as those with less advanced HIV disease. Future research will investigate the effect of UTT on long-term outcomes such as retention in care, HIV viral suppression, morbidity, and mortality.
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影响因子：
6
作者：
Iwuji, Collins;McGrath, Nuala;Porter, Kholoud
通讯作者：
Porter, Kholoud
影响因子：
11.8
作者：
Siedner, Mark J.;Ng, Courtney K.;Tsai, Alexander C.
通讯作者：
Tsai, Alexander C.
影响因子：
3.5
作者：
Porter, L;Hao, LX;Gray, R
通讯作者：
Gray, R
DOI：
10.1080/09540121.2010.525614
发表时间：
2011-01-01
影响因子：
1.7
作者：
Nakigozi, Gertrude;Makumbi, Fredrick;Wawer, Maria
通讯作者：
Wawer, Maria
影响因子：
1
作者：
Hayes R;Sabapathy K;Fidler S
通讯作者：
Fidler S