Patient-reported factors associated with reengagement among HIV-infected patients disengaged from care in East Africa.
Patient-reported factors associated with reengagement among HIV-infected patients disengaged from care in East Africa.
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DOI：
10.1097/qad.0000000000000931
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发表时间：
2016-01-28
期刊：
影响因子：
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通讯作者：
East Africa International Epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium
中科院分区：
文献类型：
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作者：
Camlin CS;Neilands TB;Odeny TA;Lyamuya R;Nakiwogga-Muwanga A;Diero L;Bwana M;Braitstein P;Somi G;Kambugu A;Bukusi EA;Glidden DV;Wools-Kaloustian KK;Wenger M;Geng EH;East Africa International Epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium
参与护理是在资源有限的情况下成功治疗艾滋病毒的关键；然而，人们对脱离护理的患者重新参与的程度和决定因素知之甚少。我们评估了患者报告的没有返回临床的原因，确定了这些原因背后的潜在变量，并检查了它们对后续护理重新投入的影响。我们使用东非国际流行病学数据库的数据来评估艾滋病，以确定一组脱离护理的患者(最后一次预约迟到3个月，报告在之前的3个月内没有接受艾滋病毒护理)(n=430)，他们接受了采访，询问了他们停止护理的原因。在399名可获得随访数据的患者中，104人在中位观察时间273天内返回临床(四分位数范围：165-325)。我们进行了探索性和验证性因素分析(EFA和CFA)，以确定潜在的潜在变量，然后在调整后的COX回归模型中将这些因素用作临床回归时间的预测因素。EFA和CFA的调查结果表明，一个由六个因素组成的结构为以下一系列障碍和动机提供了一致性：贫困、交通成本和对工作责任的干扰；医疗系统的“失败”，包括提供者治疗不善；担心艾滋病毒状况的披露；感觉健康；以及治疗疲劳/寻求精神上的药物替代品。与贫困和治疗不佳有关的因素预示着较高的临床回复率，而治疗疲劳因素则暗示着较低的回复率。再投入的某些障碍似乎比治疗疲劳等因素更容易克服。将需要进一步的研究，以确定最容易、最便宜的干预措施，使失去艾滋病毒护理系统的患者重新参与进来。人际干预可能会继续在解决留住心理障碍方面发挥重要作用。
Engagement in care is key to successful HIV treatment in resource-limited settings; yet little is known about the magnitude and determinants of reengagement among patients out of care. We assessed patient-reported reasons for not returning to clinic, identified latent variables underlying these reasons, and examined their influence on subsequent care reengagement. We used data from the East Africa International Epidemiologic Databases to Evaluate AIDS to identify a cohort of patients disengaged from care (>3 months late for last appointment, reporting no HIV care in preceding 3 months) (n = 430) who were interviewed about reasons why they stopped care. Among the 399 patients for whom follow-up data were available, 104 returned to clinic within a median observation time of 273 days (interquartile range: 165–325). We conducted exploratory and confirmatory factor analyses (EFA, CFA) to identify latent variables underlying patient-reported reasons, then used these factors as predictors of time to clinic return in adjusted Cox regression models. EFA and CFA findings suggested a six-factor structure that lent coherence to the range of barriers and motivations underlying care disengagement, including poverty, transport costs, and interference with work responsibilities; health system ‘failures,’ including poor treatment by providers; fearing disclosure of HIV status; feeling healthy; and treatment fatigue/seeking spiritual alternatives to medicine. Factors related to poverty and poor treatment predicted higher rate of return to clinic, whereas the treatment fatigue factor was suggestive of a reduced rate of return. Certain barriers to reengagement appear easier to overcome than factors such as treatment fatigue. Further research will be needed to identify the easiest, least expensive interventions to reengage patients lost to HIV care systems. Interpersonal interventions may continue to play an important role in addressing psychological barriers to retention.