Temporal changes in programme outcomes among adult patients initiating antiretroviral therapy across South Africa, 2002-2007.
Temporal changes in programme outcomes among adult patients initiating antiretroviral therapy across South Africa, 2002-2007.
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DOI：
10.1097/qad.0b013e32833d45c5
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发表时间：
2010-09-10
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影响因子：
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通讯作者：
International Epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA) Collaboration
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作者：
Cornell M;Grimsrud A;Fairall L;Fox MP;van Cutsem G;Giddy J;Wood R;Prozesky H;Mohapi L;Graber C;Egger M;Boulle A;Myer L;International Epidemiologic Databases to Evaluate AIDS Southern Africa (IeDEA-SA) Collaboration
目的：关于大规模抗逆转录病毒治疗(ART)服务迅速扩大对方案成果的暂时影响，我们知之甚少。我们描述了南非抗逆转录病毒治疗队列网络中随时间推移的患者结果[死亡率、失访(LTFU)和滞留]。设计：利用常规收集的患者数据进行队列分析。方法：分析包括2002-2007年南非8个公共部门项目中启动抗逆转录病毒治疗的成年人。2008年底，后续行动被审查。结果：登记人数(n=44 177，平均年龄35岁；68%的女性)在过去5年中增加了12倍，其中63%的患者是在过去2年中登记的。5年来，12个月死亡率从9%下降到6%。12个月LTFU每年从1%(2002/2003)增加到13%(2006年)。随着随访，累积LTFU从12个月的14%增加到36个月的29%。随着抗逆转录病毒治疗每增加一年，与记录的死亡率相比，未能留住参与者越来越多地归因于LTFU。在12个月和36个月时，80%和的患者被保留。结论：在南非，接受抗逆转录病毒治疗的人数迅速增加，但随着时间的推移，患者保留的情况也在恶化，特别是由于明显的LTFU。这可能是真正的护理损失，但也可能反映了行政错误和缺乏监测护理进出的能力。南非和其他低收入和中等收入国家需要制定新的战略，以改善对成果的监测，并随着方案规模的扩大最大限度地保留护理。
Objective:Little is known about the temporal impact of the rapid scale-up of large antiretroviral therapy (ART) services on programme outcomes. We describe patient outcomes [mortality, loss-to-follow-up (LTFU) and retention] over time in a network of South African ART cohorts.Design:Cohort analysis utilizing routinely collected patient data.Methods:Analysis included adults initiating ART in eight public sector programmes across South Africa, 2002–2007. Follow-up was censored at the end of 2008. Kaplan–Meier methods were used to estimate time to outcomes, and proportional hazards models to examine independent predictors of outcomes.Results:Enrolment (n= 44 177, mean age 35 years; 68% women) increased 12-fold over 5 years, with 63% of patients enrolled in the past 2 years. Twelve-month mortality decreased from 9% to 6% over 5 years. Twelve-month LTFU increased annually from 1%(2002/2003) to 13%(2006). Cumulative LTFU increased with follow-up from 14% at 12 months to 29% at 36 months. With each additional year on ART, failure to retain participants was increasingly attributable to LTFU compared with recorded mortality. At 12 and 36 months, respectively, 80 and 64% of patients were retained.Conclusion:Numbers on ART have increased rapidly in South Africa, but the programme has experienced deteriorating patient retention over time, particularly due to apparent LTFU. This may represent true loss to care, but may also reflect administrative error and lack of capacity to monitor movements in and out of care. New strategies are needed for South Africa and other low-income and middle-income countries to improve monitoring of outcomes and maximize retention in care with increasing programme size.