Virologic suppression and mortality of patients who migrate for HIV care in the province of British Columbia, Canada, from 2003 to 2012: a retrospective cohort study.
Virologic suppression and mortality of patients who migrate for HIV care in the province of British Columbia, Canada, from 2003 to 2012: a retrospective cohort study.
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DOI：
10.1186/s12913-015-1042-6
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发表时间：
2015-09-14
影响因子：
2.8
通讯作者：
Montaner JS
中科院分区：
文献类型：
--
作者：
Lima VD;Goldberg N;Lourenço L;Chau W;Hogg RS;Guillemi S;Barrios R;Montaner JS
艾滋病毒感染者移徙寻求艾滋病毒护理的情况很普遍，但其对资源丰富环境中健康结果的影响尚不清楚。我们进行了一项回顾性队列研究，以量化艾滋病毒携带者在不列颠哥伦比亚省（BC）内迁移治疗的程度及其与病毒学抑制和死亡率的关系。符合条件的PLWH在2003年至2012年期间首次在BC开始治疗（N = 3653）。在地区卫生监管机构（HA）层面进行分析（N = 5）。出于隐私原因，我们将这些HA的名称保持匿名，并将这五个区域重新命名为1至5。艾滋病毒携带者根据其居住和接受艾滋病毒治疗的医院管理局进行分类。我们使用不同的人口统计学方法计算了全因死亡率、预期寿命（20岁时）以及各HA的迁入、迁出和净迁移率。病毒学抑制（<50拷贝/mL）基于每个PLWH的最后可用病毒载量。我们还计算了每个HA的人均率（每100名接受cART的PLWH），方法是将PLWH人数除以该人群的医生人数。所有HA的医生可用性存在相当大的差异，根据接受治疗的HA PLWH，人均比率（每100名接受cART的PLWH）范围从2.2（HA 1）到12.7（HA 3）。我们观察到，在HA 1、4和5中，4%至10%的艾滋病毒携带者迁移到HA 3（即最大的城市中心）接受护理，而HA 2的这一比例增加到21%。在医管局第三期，77%的爱滋病病毒携带者及爱滋病患者继续留在同一间医管局接受护理。迁移到更大的HIV护理中心与更高的病毒载量抑制率无关;它与更低的死亡率和更高的预期寿命显著相关。彻底了解不列颠哥伦比亚省这些重大移民率的原因对于为资源分配提供信息和优化艾滋病毒治疗的影响至关重要。
Migration among persons living with HIV (PLWH) seeking HIV care is common; however its effect on health outcomes in resource-rich settings is not well understood. We conducted a retrospective cohort study to quantify the extent to which PLWH are migrating for care within British Columbia (BC) and its association with virologic suppression and mortality. Eligible PLWH first initiated treatment in BC between 2003 and 2012 (N = 3653). Analyses were performed at the regional Health Authority (HA) level (N = 5). For privacy reasons, we kept the name of these HAs anonymous and we re-named these five regions as 1 to 5. PLWH were classified according to the HA where they resided and received HIV care. We calculated all-cause mortality rates, life expectancies (at age of 20 years), and in, out and net migration rates across HAs using different demographic methods. Virologic suppression (<50 copies/mL) was based on the last viral load available for each PLWH. We also calculated per-capita rates (per 100 PLWH ever on cART) for each HA by dividing the number of PLWH by the number of physicians attending this population. There is considerable heterogeneity in physician availability across all HAs, with per-capita rates (per 100 PLWH ever on cART) ranging from 2.2 (HA 1) to 12.7 (HA 3) based on the HA PLWH received care. We observed that in HAs 1, 4, and 5, between 4 and 10 % of PLWH migrated to HA 3 (i.e. the largest urban center) to receive care, and for HA 2 this proportion increased to 21 %. In HA 3, 77 % of its PLWH residents remained in the same HA for their care. Migrating to a larger center for HIV care was not associated with higher rates of viral load suppression; it was significantly associated with lower mortality rates and higher life expectancies. A thorough understanding of the reason(s) for these significant migration rates across BC will be critical to inform resource allocation and optimize the impact of HIV treatment.