Early loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countries
Early loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countries
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DOI：
10.2471/blt.07.044248
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发表时间：
2008-07-01
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影响因子：
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通讯作者：
Anglaret, Xavier
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作者：
Brinkhof, Martin WG;Dabis, François;Anglaret, Xavier
目的分析在资源有限的情况下抗逆转录病毒治疗（ART）项目患者的早期流失情况。（中位年龄35岁，46%为女性）在非洲、亚洲和南美洲的15个治疗项目中，随访>= 12个月，我们研究了治疗开始后无随访的风险因素，以及前6个月内失访或死亡。结果总体而言，211名患者（3.8%）没有随访，880名（16.0%）失访，141名（2.6%）已知在前6个月内死亡。2003-2004年没有后续行动的概率高于2000年或更早的年份（比值比，OR：5.06; 95%置信区间，CI：1.28-20.0），失访也是如此（风险比，HR：7.62; 95% CI：4.55-12.8），但未记录死亡（HR：1.02; 95% CI：0.44-2.36）。与基线CD 4细胞计数≥ 50个细胞/μ l相比，计数< 25个细胞/μ l与无随访（OR：2.49; 95% CI：1.43-4.33）、失访（HR：1.48; 95% CI：1.23-1.77）和死亡（HR：3.34; 95% CI：2.10-5.30）的概率较高相关。与免费治疗相比，收费服务方案与无随访的可能性更高相关（OR：3.71; 95% CI：0.97-16.05）和较高的死亡率（HR：4.64; 95% CI：（1.11-19.41）结论：随着项目规模的扩大，早期患者流失越来越普遍，并与服务费和晚期免疫缺陷有关，基线。资源贫乏的国家需要采取措施，最大限度地保留抗逆转录病毒疗法方案。
Objective To analyse the early loss of patients to antiretroviral therapy (ART) programmes in resource-limited settings.Methods Using data on 5491 adult patients starting ART (median age 35 years, 46% female) in 15 treatment programmes in Africa, Asia and South America with >= 12 months of follow-up, we investigated risk factors for no follow-up after treatment initiation, and loss to follow-up or death in the first 6 months.Findings Overall, 211 patients (3.8%) had no follow-up, 880 (16.0%) were lost to follow-up and 141 (2.6%) were known to have died in the first 6 months. The probability of no follow-up was higher in 2003-2004 than in 2000 or earlier (odds ratio, OR: 5.06; 95% confidence interval, CI: 1.28-20.0), as was loss to follow-up (hazard ratio, HR: 7.62; 95% CI: 4.55-12.8) but not recorded death (HR: 1.02; 95% CI: 0.44-2.36). Compared with a baseline CD4-cell count >= 50 cells/mu l, a count < 25 cells/mu l was associated with a higher probability of no follow-up (OR: 2,49; 95% CI: 1.43-4.33), loss to follow-up (HR: 1.48; 95% CI: 1.23-1.77) and death (HR: 3.34; 95% CI: 2.10-5.30). Compared to free treatment, fee-for-service programmes were associated with a higher probability of no follow-up (OR: 3.71; 95% CI: 0.97-16.05) and higher mortality (HR: 4.64; 95% CI: 1.11-19.41).Conclusion Early patient losses were increasingly common when programmes were scaled up and were associated with a fee for service and advanced immunodeficiency at baseline. Measures to maximize ART programme retention are required in resource-poor countries.