Retention in clinic versus retention in care during the first year of HIV care in Nairobi, Kenya: a prospective cohort study.
Retention in clinic versus retention in care during the first year of HIV care in Nairobi, Kenya: a prospective cohort study.
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肯尼亚内罗毕艾滋病毒护理第一年的临床保留与护理保留：一项前瞻性队列研究。
DOI：
10.1002/jia2.25196
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发表时间：
2018
影响因子：
6
通讯作者：
Lester,RichardT
中科院分区：
文献类型：
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作者：
vanderKop,MiaL;Nagide,PatrickI;Thabane,Lehana;Gelmon,Lawrence;Kyomuhangi,LennieB;Abunah,Bonface;Ekström,AnnaMia;Lester,RichardT
在衡量艾滋病毒方案成功地留住患者接受护理时，很少有研究区分诊所保留（个人返回同一诊所）和护理保留（个人在初始站点或其他地方积极参与护理）。本研究的目的是量化保留在诊所与保留在护理和确定相关的风险因素与护理损耗在低收入环境中内罗毕，Keny.MethodsBetween 2013年4月和2015年6月，成人艾滋病毒检测呈阳性招募在两个综合护理诊所在非正式的城市住区。参与者从艾滋病毒检测呈阳性时起接受长达14个月的随访。在基线访视后10至14个月内没有返回诊所进行12个月预约的参与者通过电话或社区外展进行跟踪，以确定他们是否仍在接受艾滋病毒治疗。我们使用广义线性回归，以确定临床和社会人口因素之间的关联，并在12个months.ResultsOf 1068个人筛选研究参与，775个人新提出的艾滋病毒护理护理护理包括在这项研究中的磨损。在10至14个月之间，486名受试者（62.7%，95%置信区间[CI]，59.2%至66.1%）返回诊所接受12个月的预约（留在诊所）。在电话追踪和社区外展后，289名参与者中又有123人在其他艾滋病毒诊所积极接受护理（42.6%，95%CI，36.8%至48.5%）。总体而言，609名（78.6%，95% CI，75.7%至81.5%）参与者在12个月时在任何HIV诊所接受护理。基线CD 4计数较高的受试者比基线CD 4计数<200 cells/mm3.ConclusionsRetention in clinic大大低估了在这种高患病率和低收入的城市环境中接受护理后12个月的护理保留率。需要改进诊所之间追踪患者的系统，以准确估计资源有限环境中的护理保留率。虽然继续接受护理的病人比例高于预期，但需要采取干预措施，改善继续接受护理的情况，以实现结束艾滋病流行的全球目标。
IntroductionWhen measuring the success of HIV programmes to retain patients in care, few studies distinguish between retention in clinic (individual returns to the same clinic) and retention in care (individual is active in care at initial site or elsewhere). The objectives of this study were to quantify retention in clinic versus retention in care and determine risk factors associated with attrition from care in low‐income settings in Nairobi, Kenya.MethodsBetween April 2013 and June 2015, adults testing positive for HIV were recruited at two comprehensive care clinics in informal urban settlements. Participants were followed from the time of a positive HIV test for up to 14 months. Participants who did not return to the clinic for their 12‐month appointment between 10 and 14 months after their baseline visit were traced by telephone or community outreach to determine whether they were still receiving HIV care. We used generalized linear regression to determine the association between clinical and socio‐demographic factors and attrition from care at 12 months.ResultsOf the 1068 individuals screened for study participation, 775 individuals newly presenting to HIV care were included in this study. Between 10 and 14 months, 486 participants (62.7%, 95% confidence intervals [CI], 59.2% to 66.1%) returned to the clinic for their 12‐month appointment (retained in clinic). After telephone tracing and community outreach, an additional 123 of 289 participants were found to be active in care at other HIV clinics (42.6%, 95% CI, 36.8% to 48.5%). Overall, 609 (78.6%, 95% CI, 75.7% to 81.5%) participants were retained in care at any HIV clinic at 12 months. Participants in higher baseline CD4 count categories were more likely to be retained than those whose baseline CD4 count was <200 cells/mm3.ConclusionsRetention in clinic substantially underestimated retention in care 12 months after presenting to care in this high‐prevalence and low‐income urban setting. Improved systems to track patients between clinics are required to accurately estimate retention in care in resource‐limited settings. Although the proportion of patients retained in care was greater than expected, interventions to improve retention in care are needed to meet global targets to end the AIDS epidemic.