Patient retention and adherence to antiretrovirals in a large antiretroviral therapy program in Nigeria: a longitudinal analysis for risk factors.
Patient retention and adherence to antiretrovirals in a large antiretroviral therapy program in Nigeria: a longitudinal analysis for risk factors.
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DOI：
10.1371/journal.pone.0010584
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发表时间：
2010-05-11
期刊：
影响因子：
3.7
通讯作者：
Blattner W
中科院分区：
文献类型：
--
作者：
Charurat M;Oyegunle M;Benjamin R;Habib A;Eze E;Ele P;Ibanga I;Ajayi S;Eng M;Mondal P;Gebi U;Iwu E;Etiebet MA;Abimiku A;Dakum P;Farley J;Blattner W
要成功地扩大抗逆转录病毒疗法的规模，并在资源有限的情况下提供适当的艾滋病毒管理，就需要大量的资源和患者的承诺。我们在尼日利亚的一个大型治疗队列中，使用药房续药记录来评估失访（LTFU）和不依从ART的风险因素。我们回顾了2005年3月至2006年7月在五个卫生机构开始抗逆转录病毒治疗的成年患者的临床记录。如果患者在预期访视后>60天未返回，则将其归类为LTFU。计算药房续药率并用于评估不依从性。我们分别使用考克斯和广义估计方程（GEE）回归确定了与LTFU和不依从相关的风险因素。在5，760名开始ART的患者中，26%为LTFU。女性（p<0.001）、中学后教育（p = 0.03）、开始使用含齐多夫定（p = 0.004）或含替诺福韦（p = 0.05）的治疗方案与LTFU风险降低相关，而仅接受过小学教育（p = 0.02）和基线CD 4计数（cell/ml 3）>350和<100的患者与基线CD 4计数100-200的患者相比，LTFU风险较高。 调整后的GEE分析显示，年龄<35岁（p = 0.005）、前往诊所时间>2小时（p = 0.03）、总ART持续时间>6个月（p<0.001）、ART启动时CD 4计数>200的患者不依从的风险较高。 向配偶/家人透露其HIV状态（p = 0.01）并接受含替诺福韦方案治疗（p≤0.001）的患者更有可能依从。 这些发现形成了实施多个治疗前访问准备，促进披露和积极的社区外展，以支持保留和坚持的基础。将治疗护理接入点扩大到社区以减少旅行时间可能对坚持治疗产生积极影响。
Substantial resources and patient commitment are required to successfully scale-up antiretroviral therapy (ART) and provide appropriate HIV management in resource-limited settings. We used pharmacy refill records to evaluate risk factors for loss to follow-up (LTFU) and non-adherence to ART in a large treatment cohort in Nigeria. We reviewed clinic records of adult patients initiating ART between March 2005 and July 2006 at five health facilities. Patients were classified as LTFU if they did not return >60 days from their expected visit. Pharmacy refill rates were calculated and used to assess non-adherence. We identified risk factors associated with LTFU and non-adherence using Cox and Generalized Estimating Equation (GEE) regressions, respectively. Of 5,760 patients initiating ART, 26% were LTFU. Female gender (p<0.001), post-secondary education (p = 0.03), and initiating treatment with zidovudine-containing (p = 0.004) or tenofovir-containing (p = 0.05) regimens were associated with decreased risk of LTFU, while patients with only primary education (p = 0.02) and those with baseline CD4 counts (cell/ml3) >350 and <100 were at a higher risk of LTFU compared to patients with baseline CD4 counts of 100–200. The adjusted GEE analysis showed that patients aged <35 years (p = 0.005), who traveled for >2 hours to the clinic (p = 0.03), had total ART duration of >6 months (p<0.001), and CD4 counts >200 at ART initiation were at a higher risk of non-adherence. Patients who disclosed their HIV status to spouse/family (p = 0.01) and were treated with tenofovir-containing regimens (p≤0.001) were more likely to be adherent. These findings formed the basis for implementing multiple pre-treatment visit preparation that promote disclosure and active community outreaching to support retention and adherence. Expansion of treatment access points of care to communities to diminish travel time may have a positive impact on adherence.
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影响因子：
15.8
作者：
Mills EJ;Nachega JB;Bangsberg DR;Singh S;Rachlis B;Wu P;Wilson K;Buchan I;Gill CJ;Cooper C
通讯作者：
Cooper C
影响因子：
3.3
作者：
Keiser, Olivia;Anastos, Kathryn;Egger, Matthias
通讯作者：
Egger, Matthias
影响因子：
39.2
作者：
Miller, KD;Cameron, M;Kovacs, JA
通讯作者：
Kovacs, JA
DOI：
10.2471/blt.07.044248
发表时间：
2008-07-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Brinkhof, Martin WG;Dabis, François;Anglaret, Xavier
通讯作者：
Anglaret, Xavier
影响因子：
4.6
作者：
Grossberg, Robert;Gross, Robert
通讯作者：
Gross, Robert