Two-year virologic outcomes of an alternative AIDS care model: evaluation of a peer health worker and nurse-staffed community-based program in Uganda.
Two-year virologic outcomes of an alternative AIDS care model: evaluation of a peer health worker and nurse-staffed community-based program in Uganda.
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DOI：
10.1097/qai.0b013e3181988375
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发表时间：
2009-03-01
期刊：
影响因子：
--
通讯作者：
Reynolds SJ
中科院分区：
文献类型：
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作者：
Chang LW;Alamo S;Guma S;Christopher J;Suntoke T;Omasete R;Montis JP;Quinn TC;Juncker M;Reynolds SJ
越来越多的人在资源有限的情况下接受抗逆转录病毒疗法，需要人力资源来照顾这些病人，这一点越来越令人关切。我们评估了一种替代模式，即以社区为基础的全面抗逆转录病毒方案，主要由同行保健工作者和护士组成。我们对2003年底开始的项目招募的前10个月内接受抗逆转录病毒治疗的患者进行了回顾性队列研究。收集病毒学、免疫学、临床和依从性数据。在360例开始治疗的患者中，258例（72%）在大约两年后开始治疗。病毒载量检测表明，86%的活动患者（246例检测中的211例）的病毒载量<400拷贝/mL。活动期患者的中位CD 4增加为197个细胞/mm 3（IQR，108-346）。有抗逆转录病毒药物使用史或缺乏CD 4应答的患者更有可能经历病毒学失败。1年生存率为84%，2年生存率为82%。WHO 4级预测不能持续治疗和死亡率增加。在资源有限的情况下，以社区为基础的抗逆转录病毒治疗方案可以在至少两年的时间内提供良好的艾滋病护理。一个全面的计划的基础上同侪卫生工作者和护士提供了一个有效的替代模式，艾滋病护理。
There is growing concern about the human resources needed to care for increasing numbers of patients receiving antiretroviral therapy in resource-limited settings. We evaluated an alternative model, community-based, comprehensive antiretroviral program staffed primarily by peer health workers and nurses. We conducted a retrospective cohort study of patients receiving antiretroviral therapy during the first 10 months of program enrollment beginning in late 2003. Virologic, immunologic, clinical, and adherence data were collected. Of 360 patients started on treatment, 258 (72%) were active and on therapy approximately two years later. Viral load testing demonstrated that 86% of active patients (211 of 246 tested) had a viral load <400 copies/mL. The median CD4 increase for active patients was 197 cells/mm3 (IQR, 108–346). Patients with either a history of antiretroviral use or lack of CD4 response were more likely to experience virologic failure. Survival was 84% at one year and 82% at two years. WHO stage 4 was predictive of both not sustaining therapy and increased mortality. A community-based antiretroviral treatment program in a resource-limited setting can provide excellent AIDS care over at least a two year period. A comprehensive program based upon peer health workers and nurses provides an effective alternative model for AIDS care.