Effectiveness of Patient Adherence Groups as a Model of Care for Stable Patients on Antiretroviral Therapy in Khayelitsha, Cape Town, South Africa
Effectiveness of Patient Adherence Groups as a Model of Care for Stable Patients on Antiretroviral Therapy in Khayelitsha, Cape Town, South Africa
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DOI：
10.1371/journal.pone.0056088
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发表时间：
2013-02-13
期刊：
影响因子：
3.7
通讯作者：
Boulle, Andrew
中科院分区：
文献类型：
--
作者：
Luque-Fernandez, Miguel Angel;Van Cutsem, Gilles;Boulle, Andrew
背景：需要创新的护理模式来应对受影响最严重的国家中接受抗逆转录病毒治疗的患者数量不断增加的情况。这项在南非 Khayelitsha 进行的研究评估了主要由非临床工作人员运行的基于团体的护理模式在保留患者护理和保持依从性方面的有效性。方法和结果：参加“依从俱乐部”的对象是接受 ART 至少 18 个月、当前 CD4 计数 > 200 个细胞/ml 且病毒学受到抑制的成年人。 在队列研究中，我们将接受干预的患者的护理损失和病毒学反弹与2007年11月至2011年2月期间接受常规护士主导护理的患者进行了比较。我们使用逆概率加权来估计依从性俱乐部参与的意向治疗效果，并根据测量的基线和时变混杂因素进行调整。主要结局是死亡或失访。次要结果是患者的病毒学反弹 在研究开始时病毒学受到抑制的人。在 2829 名接受 ART 超过 18 个月且 CD4 计数高于 200 个细胞/μl 的患者中，有 502 名接受了俱乐部参与。研究结束时，97% 的俱乐部患者仍在接受护理，而其他患者的这一比例为 85%。在调整后的分析中，俱乐部参与将护理损失减少了 57%（风险比 [HR] 0.43，95% CI = 0.21-0.91） 最初被抑制 67% 的患者出现病毒学反弹（HR 0.33，95% CI = 0.16-0.67）。讨论：发现患者依从性小组是改善长期 ART 护理中稳定患者的保留和记录的病毒学抑制的有效模型。由非临床工作人员推动的基于临床外小组的模型是一种很有前途的方法，有助于对高负担的 ART 患者进行长期管理 低收入或中等收入环境。
Background: Innovative models of care are required to cope with the ever-increasing number of patients on antiretroviral therapy in the most affected countries. This study, in Khayelitsha, South Africa, evaluates the effectiveness of a group-based model of care run predominantly by non-clinical staff in retaining patients in care and maintaining adherence.Methods and Findings: Participation in "adherence clubs'' was offered to adults who had been on ART for at least 18 months, had a current CD4 count > 200 cells/ml and were virologically suppressed. Embedded in an ongoing cohort study, we compared loss to care and virologic rebound in patients receiving the intervention with patients attending routine nurse-led care from November 2007 to February 2011. We used inverse probability weighting to estimate the intention-to-treat effect of adherence club participation, adjusted for measured baseline and time-varying confounders. The principal outcome was the combination of death or loss to follow-up. The secondary outcome was virologic rebound in patients who were virologically suppressed at study entry. Of 2829 patients on ART for > 18 months with a CD4 count above 200 cells/mu l, 502 accepted club participation. At the end of the study, 97% of club patients remained in care compared with 85% of other patients. In adjusted analyses club participation reduced loss-to-care by 57% (hazard ratio [HR] 0.43, 95% CI = 0.21-0.91) and virologic rebound in patients who were initially suppressed by 67% (HR 0.33, 95% CI = 0.16-0.67).Discussion: Patient adherence groups were found to be an effective model for improving retention and documented virologic suppression for stable patients in long term ART care. Out-of-clinic group-based models facilitated by non-clinical staff are a promising approach to assist in the long-term management of people on ART in high burden low or middle-income settings.