Mortality and loss-to-follow-up during the pre-treatment period in an antiretroviral therapy programme under normal health service conditions in Uganda.
Mortality and loss-to-follow-up during the pre-treatment period in an antiretroviral therapy programme under normal health service conditions in Uganda.
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DOI：
10.1186/1471-2458-9-290
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发表时间：
2009-08-11
影响因子：
4.5
通讯作者：
Jaffar S
中科院分区：
文献类型：
--
作者：
Amuron B;Namara G;Birungi J;Nabiryo C;Levin J;Grosskurth H;Coutinho A;Jaffar S
在非洲的许多艾滋病毒方案中，对病人进行临床评估，并为4至12周的抗逆转录病毒治疗做准备。开始抗逆转录病毒治疗后的死亡率非常高，主要是因为患者晚期出现疾病。治疗前阶段的死亡率和保留率尚不清楚。我们进行了一项观察性研究来确定这些比率。在乌干达东南部金贾的艾滋病支持诊所就诊的艾滋病毒感染者接受了抗逆转录病毒治疗（ART）。在4-6周内进行的3次访视中，为合格受试者提供信息和咨询，以准备治疗。未完成筛选的患者在家中接受随访。生存分析采用泊松回归。对4321名艾滋病毒感染者进行了筛查，其中2483人因临床或免疫学原因有资格接受抗逆转录病毒治疗。其中，637例（26%）未完成筛查，也未开始ART治疗。男性和低CD 4计数与未完成筛查独立相关。在中位351天的随访中，181人（28%）死亡，189人（30%）报告说他们正在接受不同提供者的ART，158人（25%）活着，但说他们没有接受ART，109人（17%）失访。1个月内每100人-年的死亡率（95% CI）为34（22，55）（n. 18），3个月内为37（29，48）（n. 33）。在随访中观察到的70/158（44%）受试者表示，他们没有开始ART，因为他们负担不起交通费用。大约四分之一的受试者符合ART没有完成筛选和治疗前死亡率非常高，即使在这种情况下的患者被充分告知。对许多家庭来说，高昂的交通费用是阻碍获得抗逆转录病毒疗法的主要障碍。
In many HIV programmes in Africa, patients are assessed clinically and prepared for antiretroviral treatment over a period of 4–12 weeks. Mortality rates following initiation of ART are very high largely because patients present late with advanced disease. The rates of mortality and retention during the pre-treatment period are not well understood. We conducted an observational study to determine these rates. HIV-infected subjects presenting at The AIDS Support Clinic in Jinja, SE Uganda, were assessed for antiretroviral therapy (ART). Eligible subjects were given information and counselling in 3 visits done over 4–6 weeks in preparation for treatment. Those who did not complete screening were followed-up at home. Survival analysis was done using poisson regression. 4321 HIV-infected subjects were screened of whom 2483 were eligible for ART on clinical or immunological grounds. Of these, 637 (26%) did not complete screening and did not start ART. Male sex and low CD4 count were associated independently with not completing screening. At follow-up at a median 351 days, 181 (28%) had died, 189 (30%) reported that they were on ART with a different provider, 158 (25%) were alive but said they were not on ART and 109 (17%) were lost to follow-up. Death rates (95% CI) per 100 person-years were 34 (22, 55) (n.18) within one month and 37 (29, 48) (n.33) within 3 months. 70/158 (44%) subjects seen at follow-up said they had not started ART because they could not afford transport. About a quarter of subjects eligible for ART did not complete screening and pre-treatment mortality was very high even though patients in this setting were well informed. For many families, the high cost of transport is a major barrier preventing access to ART.
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影响因子：
168.9
作者：
Mermin, Jonathan;Were, Willy;Bunnell, Rebecca
通讯作者：
Bunnell, Rebecca
DOI：
10.2174/1874613600701010021
发表时间：
2007-01-01
期刊：
The open AIDS journal
影响因子：
--
作者：
Amuron, Barbara;Coutinho, Alex;Jaffar, Shabbar
通讯作者：
Jaffar, Shabbar
影响因子：
168.9
作者：
Braitstein, P;Brinkhof, MWG;Egger, M
通讯作者：
Egger, M
影响因子：
3.8
作者：
Etard, JF;Ndiaye, I;Delaporte, E
通讯作者：
Delaporte, E
影响因子：
1.5
作者：
Marazzi, Maria Cristina;Liotta, Giuseppe;Palombi, Leonardo
通讯作者：
Palombi, Leonardo