Characteristics and early clinical outcomes of key populations attending comprehensive community-based HIV care: Experiences from Nasarawa State, Nigeria
Characteristics and early clinical outcomes of key populations attending comprehensive community-based HIV care: Experiences from Nasarawa State, Nigeria
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DOI：
10.1371/journal.pone.0209477
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发表时间：
2018-12-20
期刊：
影响因子：
3.7
通讯作者：
Agada, Peter
中科院分区：
文献类型：
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作者：
Ibiloye, Olujuwon;Decroo, Tom;Agada, Peter
背景尽管呼吁差异化护理，但撒哈拉以南非洲地区关于针对关键人群（KP）的全面社区艾滋病毒护理的数据有限，其中包括商业性工作者（CSW）、男男性行为者（MSM）和注射吸毒者（PWID）。在尼日利亚，实施了一项与社区组织联络的计划，并提供艾滋病毒检测、当天启动抗逆转录病毒治疗以及 KP 的抗逆转录病毒治疗后续行动。在此，我们介绍了加入 ART 的 KP 及其合作伙伴。我们的目标是评估 KP 的早期治疗结果并估计 KP 流失的预测因素。方法这是一项回顾性队列研究，对 2016 年 8 月至 2017 年 11 月尼日利亚纳萨拉瓦州 KP 社区 HIV 项目常规收集的数据进行。感兴趣的变量包括社会人口统计学、KP 类型、治疗结果、ART 依从性、WHO 分期、结核病状况和病毒载量。使用汇总统计、Logistic 和 Cox 比例风险回归来描述 KP 的特征并估计自然减员的预测因子（患者失访 (LTFU) 或死亡）。 结果 710 名 (710) 名 KP 及其伴侣纳入本研究，77.3% (549) 的研究参与者为女性，中位年龄为 30 岁 (IQR: 24-35)。分别有 74.2%、4.5%、1.1% 和 20% 是 FSW、MSM、PWID 及其伴侣。在开始 ART 的 710 名 KP 中，13.9% (99/710) 在第一次就诊后停止。经过 7 个月的 ART 中位随访时间后，73.2% 的患者得以保留，23.4% 的患者接受 LTFU，3.4% 的患者死亡。缺乏正规教育（aHR 1.8；95% CI 1.3-2.6）和失业（aHR 1.8；95% CI 1.2-2.6）与人员流失显着相关。 结论 基于社区的全面艾滋病毒护理，包括艾滋病毒检测和当日抗病毒治疗是可行的。然而，在艾滋病毒确证检测的同一天开始抗逆转录病毒疗法导致了抗逆转录病毒疗法的大量采用，但可能会增加抗逆转录病毒疗法的早期流失。为了减轻 KP 在当天开始 ART 后的早期流失，应更好地评估客户的社会心理准备情况。我们强烈建议进一步研究，以了解导致 KP 高流失率的因素。
BackgroundDespite a call for differentiated care, there are limited data from sub-Saharan Africa on comprehensive community-based HIV care for key populations (KP), including commercial sex workers (CSW), men who have sex with men (MSM), and people who inject drugs (PWID). In Nigeria, a programme was implemented that liaised with community-based organizations and offered HIV testing, same-day ART initiation, and ART follow-up to KP. Here we characterize KP and their partners enrolled on ART. Our objective is to assess the early treatment outcomes and to estimate predictors of attrition among KP.MethodThis is a retrospective cohort study of routinely collected data in a community-based HIV program for KP in Nasarawa state, Nigeria from August 2016 to November 2017. Variables of interest were socio-demographic, KP types, treatment outcomes, ART adherence, WHO stage, TB status and viral load. Summary statistics, logistic and Cox proportional hazard regression were used to describe the characteristics of KP and estimate predictors of attrition (patients either lost to follow-up (LTFU) or dead).ResultSeven hundred and ten (710) KP and their partners were enrolled into this study, 77.3% (549) of study participants were female and the median age was 30 years (IQR: 24-35). Respectively, 74.2%, 4.5%, 1.1% and 20% were FSW, MSM, PWID and their partners. Of 710 KP who started ART, 13.9% (99/710) discontinued after the first visit. After a median follow-up time of 7 months on ART 73.2% of patients were retained, 23.4% were LTFU, and 3.4% were dead. Lack of formal education (aHR 1.8; 95% CI 1.3-2.6) and unemployment (aHR 1.8; 95% CI 1.2-2.6) were significantly associated with attrition.ConclusionComprehensive community-based HIV care, including HIV testing and same-day ART is feasible. However, ART initiation on the same day of confirmatory HIV testing resulted in a high uptake of ART, but possibly inflated early attrition on ART. To mitigate early attrition among KP after same-day ART initiation, the psychosocial readiness of clients should be assessed better. We strongly recommend further studies to understand factors contributing to high attrition among the KP.