Attrition from HIV treatment after enrollment in a differentiated service delivery model: A cohort analysis of routine care in Zambia.
Attrition from HIV treatment after enrollment in a differentiated service delivery model: A cohort analysis of routine care in Zambia.
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DOI：
10.1371/journal.pone.0280748
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发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
Rosen, Sydney
中科院分区：
文献类型：
--
作者：
Jo, Youngji;Jamieson, Lise;Phiri, Bevis;Grimsrud, Anna;Mwansa, Muya;Shakwelele, Hilda;Haimbe, Prudence;Mukumbwa-Mwenechanya, Mpande;Mulenga, Priscilla Lumano;Nichols, Brooke E.;Rosen, Sydney
许多撒哈拉以南非洲国家正在扩大艾滋病毒治疗的差异化服务提供(DSD)模式，以增加获得治疗的机会并消除护理障碍。在赞比亚加入DSD模型后，我们评估了与损耗相关的因素，重点关注患者水平的特征。我们使用2018年1月1日至2021年11月30日期间开始的抗逆转录病毒(ART)成人电子病历(≥15年)进行了一项回顾记录审查。减员被定义为在2021年11月30日之前失去随访(LTFU)或死亡。我们将DSD模式分为八组：快速通道、坚持组、社区接待点、家庭艺术分发、延长设施工作时间、设施多月分发(MMD，4-6个月艺术品分发)、频繁补充护理(设施1-2个月分发)和常规护理(设施3个月分发，参照组)。我们使用Fine和Gray竞争风险回归来评估患者水平与自然减员相关的因素，按性别和城乡环境分层。在547,281名符合条件的患者中，68%(n=372,409)登记了DSD模型，最常见的是设施MMD(n=306,430，82%)，频繁再充填治疗(n=47,142，13%)和快速通道(n=14,433，4%)，其中<；2%登记在其他DSD组。除了≤2个月配药组的FAST Track外，几乎所有DSD模型在所有配药间隔内的保留率都高于参照组。延长门诊时间组的患者保留效益最大，而快速配药组患者的保留效益最小。虽然HIV治疗中的保留因DSD类型、分配间隔和患者特征而不同，但几乎所有DSD模型都优于传统护理。了解影响患者在DSD模型中保留的因素可以为改进DSD的实施提供重要的一步。
Many sub-Saharan Africa countries are scaling up differentiated service delivery (DSD) models for HIV treatment to increase access and remove barriers to care. We assessed factors associated with attrition after DSD model enrollment in Zambia, focusing on patient-level characteristics. We conducted a retrospective record review using electronic medical records (EMR) of adults (≥15 years) initiated on antiretroviral (ART) between 01 January 2018 and 30 November 2021. Attrition was defined as lost to follow-up (LTFU) or died by November 30, 2021. We categorized DSD models into eight groups: fast-track, adherence groups, community pick-up points, home ART delivery, extended facility hours, facility multi-month dispensing (MMD, 4–6-month ART dispensing), frequent refill care (facility 1–2 month dispensing), and conventional care (facility 3 month dispensing, reference group). We used Fine and Gray competing risk regression to assess patient-level factors associated with attrition, stratified by sex and rural/urban setting. Of 547,281 eligible patients, 68% (n = 372,409) enrolled in DSD models, most commonly facility MMD (n = 306,430, 82%), frequent refill care (n = 47,142, 13%), and fast track (n = 14,433, 4%), with <2% enrolled in the other DSD groups. Retention was higher in nearly all DSD models for all dispensing intervals, compared to the reference group, except fast track for the ≤2 month dispensing group. Retention benefits were greatest for patients in the extended clinic hours group and least for fast track dispensing. Although retention in HIV treatment differed by DSD type, dispensing interval, and patient characteristics, nearly all DSD models out-performed conventional care. Understanding the factors that influence the retention of patients in DSD models could provide an important step towards improving DSD implementation.
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DOI：
10.1111/tmi.12460
发表时间：
2015-04
期刊：
Tropical medicine & international health : TM & IH
影响因子：
--
作者：
Duncombe C;Rosenblum S;Hellmann N;Holmes C;Wilkinson L;Biot M;Bygrave H;Hoos D;Garnett G
通讯作者：
Garnett G
影响因子：
4.5
作者：
Limbada M;Zijlstra G;Macleod D;Ayles H;Fidler S
通讯作者：
Fidler S
影响因子：
6
作者：
Long L;Kuchukhidze S;Pascoe S;Nichols BE;Fox MP;Cele R;Govathson C;Huber AN;Flynn D;Rosen S
通讯作者：
Rosen S
影响因子：
4.8
作者：
Scrucca, L.;Santucci, A.;Aversa, F.
通讯作者：
Aversa, F.
影响因子：
34.3
作者：
Hoffman, Risa M.;Moyo, Crispin;Rosen, Sydney
通讯作者：
Rosen, Sydney