Engagement in Care, Viral Suppression, Drug Resistance, and Reasons for Nonengagement After Home-Based Same-Day Antiretroviral Therapy Initiation in Lesotho: A Two-Year Follow-up of the CASCADE Trial.
Engagement in Care, Viral Suppression, Drug Resistance, and Reasons for Nonengagement After Home-Based Same-Day Antiretroviral Therapy Initiation in Lesotho: A Two-Year Follow-up of the CASCADE Trial.
复制标题
在莱索托（Lesotho）基于家庭的当天抗逆转录病毒疗法启动之后，参与护理，病毒抑制，耐药性和非参与的原因：级联试验的两年随访。
DOI：
10.1093/cid/ciz1126
复制
发表时间：
2020-12-17
期刊：
影响因子：
--
通讯作者：
Labhardt ND
中科院分区：
文献类型：
--
作者：
Amstutz A;Brown JA;Ringera I;Muhairwe J;Lejone TI;Klimkait T;Glass TR;Labhardt ND
CASCADE试验表明，与常规护理（UC）相比，在家庭人类免疫缺陷病毒检测期间提供当天（SD）抗逆转录病毒治疗（ART）可改善诊断后12个月的护理和病毒抑制。然而，关于长期结果和传播耐药性的风险仍然存在问题。在12个月完成主要终点后，追踪并鼓励两组未接受护理的参与者接受护理。在24个月时，评估了两组的以下结局：参与护理、病毒抑制和不参与的原因。此外，我们还探讨了SD臂非连接者中耐药突变（DRM）的获得。24个月时，SD组64%（88/137）vs UC组59%（81/137）接受治疗（绝对差异[AD]，5%; 95%置信区间[CI]，-6至16; P = .38），57%（78/137）vs 54%（74/137）记录到病毒抑制（AD，3%; 95%CI，-9至15; P = 0.28）。在36名参与者中，在24个月内没有得到确认的状态，大多数人拒绝与卫生系统接触或不愿意接受ART。在8名接受采访的SD臂非连接者中，6名在入组时没有启动ART，并且没有检测到获得性DRM。其中两人接受了最初30天的抗逆转录病毒药物供应，并获得了DRM。SD ART在12个月时导致更高的护理参与率和病毒抑制率，但在24个月时则不然。在UC组中，12个月后，两组之间的联系趋于平稳。我们没有观察到SD组的补偿性长期脱离。这些长期结果支持SD ART启动政策。NCT 02692027。在家庭人类免疫缺陷病毒诊断后的当天（SD）抗逆转录病毒治疗（ART）在12个月时增加了对病毒抑制护理的参与，但在24个月时没有增加，这是因为在常规护理中的后期联系。在SD ART中，我们没有观察到超过12个月的补偿性脱离护理。
The CASCADE trial showed that compared with usual care (UC), offering same-day (SD) antiretroviral therapy (ART) during home-based human immunodeficiency virus testing improved engagement in care and viral suppression 12 months after diagnosis. However, questions remain regarding long-term outcomes and the risk of propagating drug resistance. After completion of the primary endpoint at 12 months, participants not in care in both arms were traced and encouraged to access care. At 24 months, the following outcomes were assessed in both arms: engagement in care, viral suppression, and reasons for nonengagement. Furthermore, we explored the acquisition of drug resistance mutations (DRMs) among SD arm nonlinkers. At 24 months, 64% (88/137) in the SD arm vs 59% (81/137) in the UC arm were in care (absolute difference [AD], 5%; 95% confidence interval [CI], −6 to16; P = .38) and 57% (78/137) vs 54% (74/137) had documented viral suppression (AD, 3%; 95% CI, −9 to 15; P = .28). Among 36 participants alive and not in care at 24 months with ascertained status, the majority rejected contact with the health system or were unwilling to take ART. Among 8 interviewed SD arm nonlinkers, 6 had not initiated ART upon enrollment, and no acquired DRMs were detected. Two had taken the initial 30-day ART supply and acquired DRMs. SD ART resulted in higher rates of engagement in care and viral suppression at 12 months but not at 24 months. Leveling off between both arms was driven by linkage beyond 12 months in the UC arm. We did not observe compensatory long-term disengagement in the SD arm. These long-term results endorse SD ART initiation policies. NCT02692027. Same-day (SD) antiretroviral therapy (ART) after home-based human immunodeficiency virus diagnosis increased engagement in care with viral suppression at 12 months but not at 24 months due to later linkage in usual care. In SD ART, we observed no compensatory disengagement from care beyond 12 months.
登录
查看更多内容
影响因子：
16.1
作者：
Barnabas, Ruanne V.;van Rooyen, Heidi;Tumwesigye, Elioda;Murnane, Pamela M.;Baeten, Jared M.;Humphries, Hilton;Turyamureeba, Bosco;Joseph, Philip;Krows, Meighan;Hughes, James P.;Celum, Connie
通讯作者：
Celum, Connie
DOI：
10.1097/qai.0000000000000553
发表时间：
2015-05-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Fox MP;Rosen S
通讯作者：
Rosen S
影响因子：
2.5
作者：
Amstutz, Alain;Lejone, Thabo Ishmael;Labhardt, Niklaus Daniel
通讯作者：
Labhardt, Niklaus Daniel
影响因子：
15.8
作者：
Geldsetzer, Pascal;Francis, Joel M.;Baernighausen, Till
通讯作者：
Baernighausen, Till
影响因子：
3.1
作者：
Huber, Michael;Metzner, Karin J.;Zagordi, Osvaldo
通讯作者：
Zagordi, Osvaldo