Entry and retention in medical care among HIV-diagnosed persons: a meta-analysis
Entry and retention in medical care among HIV-diagnosed persons: a meta-analysis
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DOI：
10.1097/qad.0b013e32833f4b1b
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发表时间：
2010-11-13
期刊：
影响因子：
3.8
通讯作者：
Crepaz, Nicole
中科院分区：
文献类型：
--
作者：
Marks, Gary;Gardner, Lytt I.;Crepaz, Nicole
目的：减少艾滋病毒传播的“检测和治疗”战略取决于将艾滋病毒患者联系起来并保持护理，以实现抗逆转录病毒治疗的全部益处。我们整合了实证研究结果，并估计了美国艾滋病毒阳性患者在诊断后不久进入艾滋病毒医疗护理的百分比；并在指定的评估间隔内被保留在护理中。方法：我们综合检索数据库和书目列表，以确定1995年5月至2009年收集数据的研究。根据方法学变量，对进入护理和继续护理（在规定的评估间隔内多次接受艾滋病毒医疗访问）进行了单独的荟萃分析。所有的分析都使用随机效应模型。结果：总体而言，69%[95%置信区间（CI） 66-71%, N = 53 323, 28项研究结果]的美国HIV确诊患者进入了HIV医疗护理。72% （95% CI 67-77%, N 6586, 12个发现）在诊断后4个月内入院治疗。76% （95% CI 66-84%, N = 561, 15项发现）在急诊/紧急护理部门检测艾滋病毒呈阳性后进入护理，67% （95% CI 64-70%, N = 52 762, 13项发现）在社区地点进行检测后进入护理。在保留护理方面，59% （95% CI 53-65%, N = 75 655, 28项发现）在6个月至3-5年的评估间隔内平均多次接受艾滋病毒医疗护理。在较长的评估间隔期间，保留率较低。结论：美国艾滋病毒医疗保健的进入率和保留率中等。这两种结果的改善将增加检测和治疗策略的成功率。(C) 2010年Wolters Kluwer Health垂直条Lippincott Williams & Wilkins
Objective: A 'test and treat' strategy to reduce HIV transmission hinges on linking and retaining HIV patients in care to achieve the full benefit of antiretroviral therapy. We integrated empirical findings and estimated the percentage of HIV-positive persons in the United States who entered HIV medical care soon after their diagnosis; and were retained in care during specified assessment intervals.Methods: We comprehensively searched databases and bibliographic lists to identify studies that collected data from May 1995 through 2009. Separate meta-analyses were conducted for entry into care and retention in care (having multiple HIV medical visits during specified assessment intervals) stratified by methodological variables. All analyses used random-effects models.Results: Overall, 69% [95% confidence interval (CI) 66-71%, N = 53 323, 28 findings] of HIV-diagnosed persons in the United States entered HIV medical care averaged across time intervals in the studies. Seventy-two percent (95% CI 67-77%, N 6586, 12 findings) entered care within 4 months of diagnosis. Seventy-six percent (95% CI 66-84%, N 561, 15 findings) entered care after testing HIV-positive in emergency/urgent care departments and 67% (95% CI 64-70%, N = 52 762, 13 findings) entered care when testing was done in community locations. With respect to retention in care, 59% (95% CI 53-65%, N = 75 655, 28 findings) had multiple HIV medical care visits averaged across assessment intervals of 6 months to 3-5 years. Retention was lower during longer assessment intervals.Conclusion: Entry and retention in HIV medical care in the United States are moderately high. Improvement in both outcomes will increase the success of a test and treat strategy. (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins