The Therapeutic Implications of Timely Linkage and Early Retention in HIV Care
The Therapeutic Implications of Timely Linkage and Early Retention in HIV Care
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DOI：
10.1089/apc.2008.0132
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发表时间：
2009-01-01
影响因子：
4.9
通讯作者：
Mugavero, Michael J.
中科院分区：
文献类型：
--
作者：
Ulett, Kimberly B.;Willig, James H.;Mugavero, Michael J.
在艾滋病诊断后，与门诊治疗的联系，抗逆转录病毒治疗的开始，以及在护理中的纵向保留是成功治疗的基础。虽然先前的研究已经单独评估了这些过程，但尚未对同一队列患者的连续步骤进行系统评估。为了确保最佳的长期结果，需要更好地了解这些过程的相互作用。因此，本研究对2000年1月至2005年12月期间在阿拉巴马大学伯明翰分校1917年HIV/AIDS诊所接受门诊治疗的患者进行了回顾性队列研究。多变量模型确定了与以下因素相关的因素：晚期诊断/与治疗相关（初始CD4 < 350细胞/毫米(3)），及时开始抗逆转录病毒治疗，以及在治疗的头两年保持治疗。延迟连锁在总样本的三分之二（n = 567）中被观察到，并且与年龄较大（比值比[OR] = 1.31 / 10年；95%可信区间[CI] = 1.06-1.62）和非裔美国人种族（OR = 2.45; 95% CI = 1.60-3.74）相关。参加所有门诊就诊（风险比[HR] = 6.45; 95% CI 4.47-9.31）和较低的初始CD4计数导致更早开始抗逆转录病毒治疗。前两年较差的潴留与较年轻（OR = 0.68 / 10年；95% CI = 0.56-0.83）、较高的基线CD4计数和药物滥用（OR = 1.78; 95% CI = 1.16-2.73）相关。干预措施改善及时的艾滋病诊断和与护理的联系应集中在老年患者和非裔美国人身上，而改善保留的努力应针对年轻患者、CD4基线计数较高的患者和药物滥用者。错过门诊就诊是及时开始抗逆转录病毒治疗的一个重要障碍。这些数据为制定干预措施提供了信息，以改善艾滋病毒护理的联系和保留，这是一个日益重要的新兴领域。
Following HIV diagnosis, linkage to outpatient treatment, antiretroviral initiation, and longitudinal retention in care represent the foundation for successful treatment. While prior studies have evaluated these processes in isolation, a systematic evaluation of successive steps in the same cohort of patients has not yet been performed. To ensure optimal long-term outcomes, a better understanding of the interplay of these processes is needed. Therefore, a retrospective cohort study of patients initiating outpatient care at the University of Alabama at Birmingham 1917 HIV/AIDS Clinic between January 2000 and December 2005 was undertaken. Multivariable models determined factors associated with: late diagnosis/linkage to care (initial CD4 < 350 cells/mm(3)), timely antiretroviral initiation, and retention across the first two years of care. Delayed linkage was observed in two-thirds of the overall sample (n = 567) and was associated with older age (odds ratio [OR] = 1.31 per 10 years; 95% confidence interval [CI] = 1.06-1.62) and African American race (OR = 2.45; 95% CI = 1.60-3.74). Attending all clinic visits (hazard ratio [HR] = 6.45; 95% CI 4.47-9.31) and lower initial CD4 counts led to earlier antiretroviral initiation. Worse retention in the first 2 years was associated with younger age (OR = 0.68 per 10 years; 95% CI = 0.56-0.83), higher baseline CD4 count, and substance abuse (OR = 1.78; 95% CI = 1.16-2.73). Interventions to improve timely HIV diagnosis and linkage to care should focus on older patients and African Americans while efforts to improve retention should address younger patients, those with higher baseline CD4 counts, and substance abuse. Missed clinic visits represent an important obstacle to the timely initiation of antiretroviral therapy. These data inform development of interventions to improve linkage and retention in HIV care, an emerging area of growing importance.