Bridging the HIV treatment gap in Nigeria: examining community antiretroviral treatment models.
Bridging the HIV treatment gap in Nigeria: examining community antiretroviral treatment models.
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DOI：
10.1002/jia2.25108
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发表时间：
2018-04
影响因子：
6
通讯作者：
Torpey K
中科院分区：
文献类型：
--
作者：
Oladele EA;Badejo OA;Obanubi C;Okechukwu EF;James E;Owhonda G;Omeh OI;Abass M;Negedu-Momoh OR;Ojehomon N;Oqua D;Raj-Pandey S;Khamofu H;Torpey K
在向所有有需要的人提供艾滋病毒治疗方面仍然存在重大差距。在资源有限的情况下，限制向卫生保健机构提供护理将继续使这一差距持续存在。我们评估了一个大规模的基于社区的项目，以确定HIV感染者并将他们与抗逆转录病毒治疗联系起来的有效性。对尼日利亚14个高负担地方政府地区进行了回顾性长期趋势研究，其中实施了两种社区抗逆转录病毒治疗提供模式：模式A（现场启动）和模式B（立即转诊）集群。模式A集群在社区内提供服务，从艾滋病毒诊断到立即开始抗逆转录病毒治疗和一些随访。模式B集群提供艾滋病毒诊断直至基线评估的服务，并为开始抗逆转录病毒治疗提供转诊到最近的提供艾滋病毒服务的卫生机构。作为对照，我们选择了34个没有实施社区抗逆转录病毒治疗的地方政府区域，并进行了聚类匹配。关注的结局是：确定为HIV阳性的人数和开始接受抗逆转录病毒治疗的HIV阳性个体的人数；2014年6月至2016年5月。我们使用中断时间序列分析来估计干预前后的结果水平和趋势。在引入社区抗逆转录病毒治疗之前，模型A集群确定，每10万集水区人口中有500例HIV阳性（95% CI: 399.66至601.41），并启动了216例HIV阳性的抗逆转录病毒治疗（95% CI: 152.72至280.10）。模型B集群确定了32例HIV阳性（95% CI: 25.00至40.51），并启动了8例HIV阳性的抗逆转录病毒治疗（95% CI: 5.54至10.33）。引入commART后，模型A集群显示，744名HIV阳性患者（p = 0.00, 95% CI: 360.35至1127.77）和560名HIV阳性患者（p = 0.00, 95% CI: 260.56至859.64）立即显著增加。模型B集群显示，30名HIV阳性患者立即显著增加（p = 0.01, 95% CI: 8.38至51.93），但开始治疗的HIV阳性患者数量没有显著增加。模型B组显示两个结果逐月增加的趋势（3.4,p = 0.02, 95% CI: 0.44至6.38）。两种社区模型在快速识别艾滋病毒感染者方面具有相似的人群水平有效性，但在有效地将他们转移到治疗方面存在差异。在设计社区提供抗逆转录病毒治疗时，全面性、整体性和对护理障碍的关注是重要的。
Significant gaps persist in providing HIV treatment to all who are in need. Restricting care delivery to healthcare facilities will continue to perpetuate this gap in limited resource settings. We assessed a large‐scale community‐based programme for effectiveness in identifying people living with HIV and linking them to antiretroviral treatment. A retrospective secular trend study of 14 high burden local government areas of Nigeria was conducted in which two models of community antiretroviral treatment delivery were implemented: Model A (on‐site initiation) and Model B (immediate referral) clusters. Model A cluster offered services within communities, from HIV diagnosis to immediate antiretroviral therapy initiation and some follow‐up. Model B cluster offered services for HIV diagnosis up to baseline evaluation and provided referral for antiretroviral therapy initiation to nearest health facility providing HIV services. For controls, we selected and cluster‐matched 34 local government areas where community antiretroviral treatment delivery was not implemented. Outcomes of interest were: the number of people identified as HIV positive and the number of HIV‐positive individuals started on antiretroviral treatment; from June 2014 to May 2016. We used interrupted time‐series analysis to estimate outcome levels and trends across the pre‐and post‐intervention periods. Before community antiretrovial treatment introduction, Model A cluster identified, per 100,000 catchment population, 500 HIV‐positives (95% CI: 399.66 to 601.41) and initiated 216 HIV‐positives on antiretroviral treatment (95% CI: 152.72 to 280.10). Model B cluster identified 32 HIV‐positives (95% CI: 25.00 to 40.51) and initiated 8 HIV‐positives on antiretroviral treatment (95% CI: 5.54 to 10.33). After commART introduction, Model A cluster showed an immediate significant increase in 744 HIV‐positive persons (p = 0.00, 95% CI: 360.35 to 1127.77) and 560 HIV‐positives initiated on treatment (p = 0.00, 95% CI: 260.56 to 859.64). Model B cluster showed an immediate significant increase in 30 HIV‐positive persons identified (p = 0.01, 95% CI: 8.38 to 51.93) but not in the number of HIV‐positives initiated on treatment. Model B cluster showed increased month‐on‐month trends of both outcomes of interest (3.4, p = 0.02, 95% CI: 0.44 to 6.38). Both community‐models had similar population‐level effectiveness for rapidly identifying people living with HIV but differed in effectively transitioning them to treatment. Comprehensiveness, integration and attention to barriers to care are important in the design of community antiretroviral treatment delivery.
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影响因子：
1.4
作者：
Lahuerta M;Ue F;Hoffman S;Elul B;Kulkarni SG;Wu Y;Nuwagaba-Biribonwoha H;Remien RH;El Sadr W;Nash D
通讯作者：
Nash D
影响因子：
34.3
作者：
Ezeanolue, Echezona E.;Obiefune, Michael C.;Ogedegbe, Gbenga
通讯作者：
Ogedegbe, Gbenga
影响因子：
2.2
作者：
Okoboi, Stephen;Ding, Erin;Moore, David M.
通讯作者：
Moore, David M.
优化乌干达社区抗逆转录病毒治疗项目临床效率的策略。
影响因子：
4.4
作者：
Alamo, Stella T.;Wagner, Glenn J.;Ouma, Joseph;Sunday, Pamela;Marie, Laga;Colebunders, Robert;Wabwire-Mangen, Fred
通讯作者：
Wabwire-Mangen, Fred
影响因子：
120.7
作者：
MacPherson, Peter;Lalloo, David G.;Corbett, Elizabeth L.
通讯作者：
Corbett, Elizabeth L.