Retention in HIV care for individuals not yet eligible for antiretroviral therapy: rural KwaZulu-Natal, South Africa.
Retention in HIV care for individuals not yet eligible for antiretroviral therapy: rural KwaZulu-Natal, South Africa.
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DOI：
10.1097/qai.0b013e3182075ae2
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发表时间：
2011-03-01
期刊：
影响因子：
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通讯作者：
Newell ML
中科院分区：
文献类型：
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作者：
Lessells RJ;Mutevedzi PC;Cooke GS;Newell ML
确定尚未符合抗逆转录病毒治疗（ART）条件的个人在艾滋病毒护理中的保留情况，并探讨与保留农村公共卫生艾滋病毒方案相关的因素。2007年1月至2007年12月，尚未符合ART条件的HIV感染成人（≥16岁），CD 4细胞计数> 200个细胞/μl，均纳入分析。通过13个月内的重复CD 4计数来定义保留。与保留相关的因素进行了评估，使用逻辑回归与临床水平的聚类。4，223人被纳入分析（83.9%为女性）。总体保留率为44.9%，中位恢复时间为201天（四分位距[IQR] 127-274）。初始CD 4计数201-350、351-500和>500个细胞/μl的保留率分别为51.6%（95%置信区间[CI] 49.1-54.0）、43.2%（95% CI 40.5-45.9）和34.9%（95% CI 32.4-37.4）。与CD 4 201-350个细胞/μl相比，较高的初始CD 4计数与较低的滞留几率显著相关（CD 4 351-500个细胞/μl调整的比值比[aOR] 0.72，95% CI 0.62-0.84; CD 4>500个细胞/μl aOR 0.51，95% CI 0.44-0.60）。男性与较低的几率（aOR 0.80，95% CI 0.67-0.96）独立相关，年龄越大，保留几率越高（每增加一岁aOR 1.03，95% CI 1.03-1.04）。在有资格接受抗逆转录病毒治疗之前，艾滋病毒护理的保留率很低，特别是对年轻人和感染早期的人。需要进一步努力优化和评估护理和监测战略，以充分实现撒哈拉以南非洲艾滋病毒方案迅速扩大的好处。
To determine retention in HIV care for individuals not yet eligible for antiretroviral therapy (ART) and to explore factors associated with retention in a rural public health HIV programme. HIV-infected adults (≥16 years) not yet eligible for ART, with CD4 cell count >200cells/μl January 2007 - December 2007 were included in the analysis. Retention was defined by repeat CD4 count within 13 months. Factors associated with retention were assessed using logistic regression with clustering at clinic level. 4,223 were included in the analysis (83.9% female). Overall retention was 44.9% with median time to return 201 days (interquartile range [IQR] 127-274). Retention by initial CD4 count 201-350, 351-500, and >500 cells/μl was 51.6% (95% confidence interval [CI] 49.1-54.0), 43.2% (95% CI 40.5-45.9), and 34.9% (95% CI 32.4-37.4) respectively. Compared to CD4 201-350 cells/μl, higher initial CD4 count was significantly associated with lower odds of retention (CD4 351-500 cells/μl adjusted odds ratio [aOR] 0.72, 95% CI 0.62-0.84; CD4 >500 cells/μl aOR 0.51, 95% CI 0.44-0.60). Male sex was independently associated with lower odds (aOR 0.80, 95% CI 0.67-0.96), and older age with higher odds of retention (for each additional year of age aOR 1.03, 95% CI 1.03-1.04). Retention in HIV care prior to eligibility for ART is poor, particularly for younger individuals and those at an earlier stage of infection. Further work to optimise and evaluate care and monitoring strategies is required to realise the full benefits of the rapid expansion of HIV programmes in sub-Saharan Africa.