Predictors of delayed Anti-Retroviral Therapy initiation among adults referred for HIV treatment in Uganda: a cross-sectional study.
Predictors of delayed Anti-Retroviral Therapy initiation among adults referred for HIV treatment in Uganda: a cross-sectional study.
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DOI：
10.1186/s12913-023-09052-z
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发表时间：
2023-01-16
影响因子：
2.8
通讯作者：
中科院分区：
文献类型：
--
作者：
乌干达现行指南建议对艾滋病病毒感染者立即启动抗逆转录病毒治疗（ART），以降低与艾滋病相关的发病率和死亡率。然而，并非所有符合条件的艾滋病病毒感染者在确诊后都能在推荐时间内启动抗逆转录病毒治疗。我们评估了在推出检测和治疗指南五年后，被转介启动抗逆转录病毒治疗的艾滋病病毒感染者中延迟启动治疗的患病率及其相关因素。
在这项横断面研究中，我们纳入了2017年1月至2021年5月期间被转介到穆拉戈免疫抑制综合征（Mulago ISS）诊所启动抗逆转录病毒治疗的成年患者。我们使用问卷收集了社会人口统计学、艾滋病病毒诊断和转介情况以及启动抗逆转录病毒治疗的时间等数据。关注的结果是延迟抗逆转录病毒治疗的患者比例，定义为从艾滋病病毒诊断到启动抗逆转录病毒治疗超过30天。我们进行了多变量逻辑回归分析，并确定了显著因素。
共有312名患者入组，其中62.2%为女性。患者的年龄中位数（四分位间距[IQR]）和基线CD4细胞计数分别为35（28 - 42）岁和315（118.8 - 580.5）个/微升。48名（15.4%）患者延迟启动抗逆转录病毒治疗，启动抗逆转录病毒治疗的时间中位数（IQR）为92（49.0 - 273.5）天。与延迟启动抗逆转录病毒治疗相关的因素包括：1）在私立医疗机构而非公立医疗机构确诊艾滋病病毒感染（调整后的比值比[aOR]=2.4（95%置信区间[CI]1.1 - 5.5））；2）最初否认艾滋病病毒检测阳性结果，aOR = 5.4（95% CI：2.0 - 15.0）；以及3）未接到艾滋病病毒诊断机构的随访电话，aOR = 2.8（95% CI：1.2 - 6.8）。
在乌干达推出检测和治疗指南后的5年内，被转介的艾滋病病毒感染者中启动抗逆转录病毒治疗存在显著延迟。艾滋病医疗服务连续性方面的卫生系统挑战对乌干达被转介的艾滋病病毒感染者及时启动抗逆转录病毒治疗产生了负面影响。
Uganda’s current guidelines recommend immediate initiation of Anti-Retroviral Therapy (ART) for persons living with HIV in order to reduce HIV/AIDS related morbidity and mortality. However, not all eligible PLHIV initiate ART within the recommended time following HIV diagnosis. We assessed the prevalence and factors associated with delayed ART initiation among PLHIV referred for ART initiation, five years since rolling out the test and treat guidelines. In this cross-sectional study, we enrolled adult patients referred to Mulago Immune Suppressive Syndrome (Mulago ISS) clinic for ART initiation from January 2017 to May 2021. We collected data on socio-demographics, HIV diagnosis and referral circumstances, and time to ART initiation using a questionnaire. The outcome of interest was proportion of patients that delayed ART, defined as spending more than 30 days from HIV diagnosis to ART initiation. We performed multivariable logistic regression and identified significant factors. A total of 312 patients were enrolled of which 62.2% were female. The median (inter-quartile range [IQR]) age and baseline CD4 count of the patients were 35 (28–42) years and 315 (118.8–580.5) cells/μL respectively. Forty-eight (15.4%) patients delayed ART initiation and had a median (IQR) time to ART of 92 (49.0–273.5) days. The factors associated with delayed ART initiation were; 1) having had the HIV diagnosis made from a private health facility versus public, (adjusted odds ratio [aOR] = 2.4 (95% confidence interval [CI] 1.1–5.5); 2) initial denial of positive HIV test results, aOR = 5.4 (95% CI: 2.0–15.0); and, 3) having not received a follow up phone call from the place of HIV diagnosis, aOR = 2.8 (95% CI: 1.2–6.8). There was significant delay of ART initiation among referred PLHIV within 5 years after the rollout of test and treat guidelines in Uganda. Health system challenges in the continuity of HIV care services negatively affects timely ART initiation among referred PLHIV in Uganda.
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影响因子：
3.7
作者：
Ayieko J;Brown L;Anthierens S;Van Rie A;Getahun M;Charlebois ED;Petersen ML;Clark TD;Kamya MR;Cohen CR;Bukusi EA;Havlir DV;Camlin CS
通讯作者：
Camlin CS
影响因子：
120.7
作者：
Labhardt, Niklaus D.;Ringera, Isaac;Glass, Tracy R.
通讯作者：
Glass, Tracy R.
影响因子：
3.3
作者：
Moges NA;Adesina OA;Okunlola MA;Berhane Y
通讯作者：
Berhane Y
影响因子：
3.7
作者：
Balachandra, S.;Rogers, J. H.;Apollo, T.
通讯作者：
Apollo, T.
影响因子：
2.6
作者：
Chihana, Menard L.;Huerga, Helena;Davies, Mary-Ann
通讯作者：
Davies, Mary-Ann