Compound Retention in Care and All-Cause Mortality Among Persons Living With Human Immunodeficiency Virus
Compound Retention in Care and All-Cause Mortality Among Persons Living With Human Immunodeficiency Virus
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DOI：
10.1093/ofid/ofz120
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发表时间：
2019-04-01
影响因子：
4.2
通讯作者：
Mugavero, Michael J.
中科院分区：
文献类型：
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作者：
Kay, Emma Sophia;Batey, D. Scott;Mugavero, Michael J.
背景为了获得最佳的健康结果，艾滋病毒感染者必须继续接受临床护理。我们研究了2个独立的保留措施（漏诊和医学研究所[IOM]指标）和全因死亡率的4种可能组合之间的关系。样本包括4162名抗逆转录病毒治疗（ART）初治患者，他们在2000年1月至2010年7月期间在美国综合临床系统艾滋病研究网络中心的5个站点中的任何一个开始ART。关注的自变量是保留，捕获超过12个月的时间内开始ART。研究结果，全因死亡率开始ART后1年，通过查询社会保障死亡指数或国家死亡指数。我们使用考克斯比例风险模型评估了4类保留与全因死亡率的相关性。10%的患者不符合任一指标的保留标准（风险比[HR]，2.26; 95%置信区间[CI]，1.59-3.21）。与通过两种措施保留的患者（41%）相比，通过IOM保留但未通过错过访视措施保留的患者（42%）的死亡率HR（1.72; 95%CI，1.33-2.21）更高。通过遗漏访视而非IOM措施保留的患者（6%）与通过两种措施保留的患者具有相同的死亡风险（HR，1.01; 95% CI，0.54 -1.87）。在开始抗逆转录病毒治疗的前12个月内错过就诊是随后死亡的主要风险因素。建议在临床和公共卫生保留和病毒抑制规划中补充漏诊。
Background. To obtain optimal health outcomes, persons living with human immunodeficiency virus (HIV) must be retained in clinical care. We examined the relationships between 4 possible combinations of 2 separate retention measures (missed visits and the Institute of Medicine [IOM] indicator) and all-cause mortality.Methods. The sample included 4162 antiretroviral therapy (ART)-naive patients who started ART between January 2000 and July 2010 at any of 5 US sites of the Center for AIDS Research Network of Integrated Clinical Systems. The independent variable of interest was retention, captured over the 12-month period after the initiation of ART. The study outcome, all-cause mortality 1 year after ART initiation, was determined by querying the Social Security Death Index or the National Death Index. We evaluated the associations of the 4 categories of retention with all-cause mortality, using the Cox proportional hazards models.Results. Ten percent of patients did not meet retention standards for either measure (hazard ratio [HR], 2.26; 95% confidence interval [CI], 1.59-3.21). Patients retained by the IOM but not the missed-visits measure (42%) had a higher HR for mortality (1.72; 95% CI, 1.33-2.21) than patients retained by both measures (41%). Patients retained by the missed-visits but not the IOM measure (6%) had the same mortality hazards as patients retained by both measures (HR, 1.01; 95% CI,.54-1.87).Conclusions. Missed visits within the first 12 months of ART initiation are a major risk factor for subsequent death. Incorporating missed visits in clinical and public health retention and viral suppression programming is advised.