Retention on antiretroviral therapy during Universal Test and Treat implementation in Zomba district, Malawi: a retrospective cohort study
Retention on antiretroviral therapy during Universal Test and Treat implementation in Zomba district, Malawi: a retrospective cohort study
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DOI：
10.1002/jia2.25239
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发表时间：
2019-02-01
影响因子：
6
通讯作者：
van Oosterhout, Joep J.
中科院分区：
文献类型：
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作者：
Alhaj, Mohammad;Amberbir, Alemayehu;van Oosterhout, Joep J.
自2016年6月以来，马拉维的国家艾滋病毒规划采用了通用测试和治疗（UTT）指南，要求所有艾滋病毒检测呈阳性的人都将被转介开始抗逆转录病毒治疗（ART）。虽然有强有力的证据，从临床试验表明，早期启动的ART导致发病率和死亡率降低，UTT的影响保留在现实生活中的程序设置在非洲的ART尚不知道。马拉维将比较根据2016年UTT指南启动ART的患者和在UTT推出之前（UTT前）开始ART的患者的ART结果。我们分析了来自32个不同规模的农村和城市卫生设施的数据。使用考克斯比例风险模型确定12个月时ART损耗的独立风险因素。使用稳健的标准误方法对所有分析进行了调整，以按卫生机构进行聚类。结果在研究期间开始ART的1492名患者（平均年龄34.4岁，933名（63%）女性）中，有501名入组了UTT前队列，911名入组了UTT期间。在12个月时，UTT队列中ART的保留率高于UTT前队列83.0%（95%置信区间（CI）：81.0%至85.0%）与76.2%（95% CI：73.9%至78.5%）。青少年，年龄在10至19岁（调整后的风险比（aHR）1.53; 95%CI 1.01至2.32），和妇女谁是怀孕或母乳喂养在ART启动（aHR 1.87; 95%CI 1.30至2.38）是在合并前UTT和UTT coherent.ConclusionsRetention在ART是近6%高UTT引入后的摩擦风险。年轻人和妇女谁是怀孕或哺乳期开始抗逆转录病毒治疗的风险增加，强调需要有针对性的干预措施，这些群体实现90-90-90艾滋病规划署的目标，在UTT时代。
IntroductionSince June 2016, the national HIV programme in Malawi has adopted Universal Test and Treat (UTT) guidelines requiring that all persons who test HIV positive will be referred to start antiretroviral therapy (ART). Although there is strong evidence from clinical trials that early initiation of ART leads to reduced morbidity and mortality, the impact of UTT on retention on ART in real-life programmatic settings in Africa is not yet known.MethodsWe conducted a retrospective cohort study in Zomba district, Malawi to compare ART outcomes of patients who initiated ART under 2016 UTT guidelines and those who started ART prior to rollout of UTT (pre-UTT). We analysed data from 32 rural and urban health facilities of various sizes. Cox proportional hazards modelling was used to determine the independent risk factors of attrition from ART at 12months. All analyses were adjusted for clustering by health facility using a robust standard errors approach.ResultsAmong 1492 patients (mean age 34.4years, 933 (63%) female) who initiated ART during the study period, 501 were enrolled in the pre-UTT cohort and 911 during UTT. At 12months, retention on ART in the UTT cohort was higher than in the pre-UTT cohort 83.0% (95% confidence interval (CI): 81.0% to 85.0%) versus 76.2% (95% CI 73.9% to 78.5%). Adolescents, aged 10 to 19years (adjusted hazard ratio (aHR) 1.53; 95% CI 1.01 to 2.32), and women who were pregnant or breastfeeding at ART initiation (aHR 1.87; 95% CI 1.30 to 2.38) were at higher risk of attrition in the combined pre-UTT and UTT cohort.ConclusionsRetention on ART was nearly 6% higher after UTT introduction. Young adults and women who were pregnant or breastfeeding at the start of ART were at increased risk of attrition, emphasizing the need for targeted interventions for these groups to achieve the 90-90-90 UNAIDS targets in the UTT era.