Community-based ART distribution system can effectively facilitate long-term program retention and low-rates of death and virologic failure in rural Uganda
Community-based ART distribution system can effectively facilitate long-term program retention and low-rates of death and virologic failure in rural Uganda
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DOI：
10.1186/s12981-015-0077-4
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发表时间：
2015-11-12
影响因子：
2.2
通讯作者：
Moore, David M.
中科院分区：
文献类型：
--
作者：
Okoboi, Stephen;Ding, Erin;Moore, David M.
背景：社区药物分发点是为社区内稳定的患者提供的一种护理模式，旨在使抗逆转录病毒治疗对卫生系统更有效率，并提供适当的支持，以鼓励患者长期留存。我们调查了乌干达农村地区抗逆转录病毒治疗项目参与者的计划保留率，自2004年以来，乌干达农村地区一直使用基于社区的抗逆转录病毒治疗分配模式。方法：我们分析了2004年1月1日至2009年7月31日期间在乌干达艾滋病支持组织网站金贾发起抗逆转录病毒治疗的所有患者的数据。参与者每2-3个月参加一次诊所或外展访问，每6个月测量一次CD4细胞计数。保留护理的定义是指在2013年6月1日之前的6个月内至少就诊一次的患者。然后，我们确定了在2013年6月1日之前的6个月内至少有一次就诊的参与者，并检查了与死亡率和失访(LTFU)的关系。在2012年8月至2013年5月期间进行了4年随访的参与者进行了病毒载量测试，因为没有常规的病毒载量检测。结果：2004-2009年共有3345名参与者开始抗逆转录病毒治疗。2013年6月，接受抗逆转录病毒治疗的时间中值为5.69年。共有1335人(40%)居住在金家区，2005年(60%)居住在边远地区。在这些人中，2322人(69%)仍在接受护理，577人(17%)死亡，161人(5%)转出，285人(9%)为LTFU。与死亡率或LTFU相关的因素包括男性、[调整后危险比(AHR)=1.56；95%可信区间1.28-1.9]、CD4细胞计数
Background: Community-drug distribution point is a care model for stable patients in the community designed to make ART delivery more efficient for the health system and provide appropriate support to encourage long-term retention of patients. We examined program retention among ART program participants in rural Uganda, which has used a community-based distribution model of ART delivery since 2004.Methods: We analyzed data of all patients >18 years who initiated ART in Jinja, Ugandan site of The AIDS Support Organization between January 1, 2004 and July 31, 2009. Participants attended clinic or outreach visits every 2-3 months and had CD4 cell counts measured every 6 months. Retention to care was defined as any patient with at least one visit in the 6 months before June 1, 2013. We then identified participants with at least one visit in the 6 months before June 1, 2013 and examined associations with mortality and lost-to-follow-up (LTFU). Participants with >4 years of follow up during August, 2012 to May, 2013 had viral load conducted, since no routine viral load testing was available.Results: A total of 3345 participants began ART during 2004-2009. The median time on ART in June 2013 was 5.69 years. A total of 1335 (40 %) were residents of Jinja district and 2005 (60 %) resided in outlying districts. Of these, 2322 (69 %) were retained in care, 577 (17 %) died, 161 (5 %) transferred out and 285 (9 %) were LTFU. Factors associated with mortality or LTFU included male gender, [Adjusted Hazard Ratio (AHR) = 1.56; 95 % CI 1.28-1.9], CD4 cell count