Differentiated HIV care in sub-Saharan Africa: a scoping review to inform antiretroviral therapy provision for stable HIV-infected individuals in Kenya
Differentiated HIV care in sub-Saharan Africa: a scoping review to inform antiretroviral therapy provision for stable HIV-infected individuals in Kenya
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DOI：
10.1080/09540121.2018.1500995
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发表时间：
2018-01-01
影响因子：
1.7
通讯作者：
Cohen, Craig R.
中科院分区：
文献类型：
--
作者：
Hagey, Jill M.;Li, Xuan;Cohen, Craig R.
撒哈拉以南非洲在提供抗逆转录病毒疗法方面存在许多差距。差别化的艾滋病毒护理根据患者的病情程度为患者量身定制抗逆转录病毒疗法，为在何处、由谁以及多久进行一次护理提供替代方案。我们进行了一项范围审查，以评估新的差异化护理模式，为稳定的艾滋病毒感染的成年人在撒哈拉以南非洲地区的ART提供，以及如何使用这些模型来指导差异化护理在肯尼亚的实施。在2006年1月至2017年1月期间，使用PubMed、Embase、Web of Science、Popline、科克伦图书馆和非洲医学索引进行了系统检索。灰色文献检索和手工检索也被使用。我们纳入了定量评估差异化HIV护理的健康、可接受性和成本效益的文章。两名评审员独立进行文章筛选、数据提取和确定纳入分析。我们纳入了40篇出版物，涉及撒哈拉以南非洲9个国家的240，000多名参与者- 54.4%评价了临床结局，23.5%评价了可接受性结局，22.1%评价了成本结局。差别化护理模式包括：设施快速通道药物补充和预约间隔，设施或社区为基础的抗逆转录病毒治疗小组，社区抗逆转录病毒治疗分发点或家庭护理，以及任务转移或分散护理。研究表明，这些方法在抑制病毒载量和保持护理方面具有相似的结果，是标准艾滋病毒护理的可接受替代方案。对于调查任务转移的研究和报告成本效益结果的研究，无法推断出明确的结果。肯尼亚已开始推广差别化护理模式，但随着不同模式的推出，应进行进一步的评估、质量改进和研究。
Many gaps in care exist for provision of antiretroviral therapy (ART) in sub-Saharan Africa. Differentiated HIV care tailors provision of ART for patients based on their level of acuity, providing alternatives for where, by whom, and how often care occurs. We conducted a scoping review to assess novel differentiated care models for ART provision for stable HIV-infected adults in sub-Saharan Africa, and how these models can be used to guide differentiated care implementation in Kenya. A systematic search was conducted using PubMed, Embase, Web of Science, Popline, Cochrane Library, and African Index Medicus between January 2006 and January 2017. Grey literature searches and handsearching were also used. We included articles that quantitatively assessed the health, acceptability, and cost-effectiveness of differentiated HIV care. Two reviewers independently performed article screening, data extraction and determination of inclusion for analysis. We included 40 publications involving over 240,000 participants spanning nine countries in sub-Saharan Africa - 54.4% evaluated clinical outcomes, 23.5% evaluated acceptability outcomes, and 22.1% evaluated cost outcomes. Differentiated care models included: facility fast-track drug refills and appointment spacing, facility or community-based ART groups, community ART distribution points or home-based care, and task-shifting or decentralization of care. Studies suggest that these approaches had similar outcomes in viral load suppression and retention in care and were acceptable alternatives to standard HIV care. No clear results could be inferred for studies investigating task shifting and those reporting cost-effectiveness outcomes. Kenya has started to scale up differentiated care models, but further evaluation, quality improvement and research studies should be performed as different models are rolled out.