Effective public-private partnerships for sustainable antiretroviral therapy: outcomes of the Right to Care health services GP down-referral program
Effective public-private partnerships for sustainable antiretroviral therapy: outcomes of the Right to Care health services GP down-referral program
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DOI：
10.1186/s12889-019-7660-x
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发表时间：
2019-11-07
影响因子：
4.5
通讯作者：
Onoya, Dorina
中科院分区：
文献类型：
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作者：
Mokhele, Idah;Mashamaite, Sello;Onoya, Dorina
背景最近在南非增加了获得抗逆转录病毒疗法（ART）的机会，这给公共卫生部门的人力和基础设施资源带来了额外的压力。私营部门的全科医生（全科医生）的能力，可以利用，以减轻目前的负担，对公共卫生sect.MethodsWe进行了回顾性记录审查的常规电子病历数据的系统样本的艾滋病毒感染的成年人（≥ 18岁）在约翰内斯堡一家三级医院艾滋病毒门诊开始抗逆转录病毒治疗，南非，并在ART稳定后转介私人全科医生继续治疗。（“GP下转介”）至仍留在转介中心的对照队列（“诊所A”）和来自不提供向下转诊给全科医生的地区医院门诊HIV诊所的患者（“诊所B”）。研究结果评估的病毒载量抑制（VL 90天后，最后一次预定的访问）由12个月的后续下转介或eligibility.ResultsA共3685例，包括373（10.1%）GP下转介，2599（70.5%）诊所A控制，和713（19.4%）诊所B控制被列入分析。总体而言，1535例患者（53.3%）的病毒载量受到抑制。与诊所A和B患者相比，GP下转介患者中病毒载量受抑制的比例较高（65.7% vs 49.1% vs 58.9%）。在调整人口统计学和基线临床协变量后，我们发现GP下转介和对照患者之间的病毒载量抑制没有差异（门诊A与GP的校正相对风险[aRR]下降至1.0; 95% CI：0.9-1.1），（门诊B与GP的aRR下降至1.0; 95% CI：0.9-1.2）。与GP下转介和诊所A对照相比，诊所B对照经历了最高的损耗（33.2% vs 11.3% vs 5.9%），与GP下转患者相比，（校正的风险比[aHR] 4.2; 95% CI：2.8-6.5），而门诊B对照组的损耗风险较低（aHR 0.5; 95%CI：0.3-0.7）。结论和说明我们的研究结果表明，私人全科医生可以帮助照顾稳定的公共部门HIV患者终身ART。然而，他们需要特别努力，以提高保留在护理。
BackgroundThe recently increased access to antiretroviral therapy (ART) in South Africa has placed additional strain on human and infrastructure resources of the public health sector. Capacity from private-sector General Practitioners (GPs) could be leveraged to ease the current burden on the public health sector.MethodsWe conducted a retrospective record review of routine electronic medical record data on a systematic sample of HIV-infected adults (>= 18years old) initiated on ART at a tertiary hospital outpatient HIV clinic in Johannesburg, South Africa and down-referred to private-GPs for continued care after stabilization on ART. We compared these patients ("GP down-referred") to a control-cohort who remained at the referring site ("Clinic A") and patients from a regional hospital outpatient HIV clinic not offering down-referral to GPs ("Clinic B"). Study outcomes assessed are viral load suppression (VL90-days late for a last-scheduled visit) by 12months of follow-up following down-referral or eligibility.ResultsA total of 3685 patients, comprising 373 (10.1%) GP down-referred, 2599 (70.5%) clinic A controls, and 713 (19.4%) clinic B controls were included in the analysis. Overall, 1535 patients (53.3%) had a suppressed viral load. A higher portion of GP down-referred patients had a suppressed viral load compared to clinic A and B patients (65.7% vs 49.1% vs 58.9%). After adjusting for demographic and baseline clinical covariates, we found no difference in viral load suppression between GP down-referred and control patients (adjusted relative risk [aRR] for clinic A vs GP down-referred 1.0; 95% CI: 0.9-1.1), (aRR for clinic B vs GP down-referred 1.0; 95% CI: 0.9-1.2).Clinic B controls experienced the highest attrition compared to GP down-referred and clinic A controls (33.2% vs 11.3% vs 5.9%) and had a higher risk of attrition compared to GP down-referred patients (adjusted hazard ratio [aHR] 4.2; 95% CI: 2.8-6.5), whereas clinic B controls had a lower risk of attrition (aHR 0.5; 95% CI: 0.3-0.7).Conclusions and recommendationsOur results show that private-GPs can contribute to caring for stabilized public sector HIV patients on life-long ART. However, they require special efforts to improve retention in care.