Patterns and Predictors of Incident Return to HIV Care Among Traced, Disengaged Patients in Zambia: Analysis of a Prospective Cohort.
Patterns and Predictors of Incident Return to HIV Care Among Traced, Disengaged Patients in Zambia: Analysis of a Prospective Cohort.
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赞比亚追踪的非接触患者中事件返回HIV护理的模式和预测因素：一项前瞻性队列分析。
DOI：
10.1097/qai.0000000000002554
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发表时间：
2021-03-01
期刊：
影响因子：
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通讯作者：
Geng E
中科院分区：
文献类型：
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作者：
Beres LK;Schwartz S;Simbeza S;McGready J;Eshun-Wilson I;Mwamba C;Sikombe K;Topp SM;Somwe P;Mody A;Mukamba N;Ehrenkranz PD;Padian N;Pry J;Moore CB;Holmes CB;Sikazwe I;Denison JA;Geng E
补充数字内容在文本中可用。患者进出艾滋病毒护理的动态移动很普遍，但关于患者重新参与模式或回归预测因素的信息有限，无法指导艾滋病毒方案更好地支持患者参与。从一个基于概率的样本失去了后续行动，成人患者追踪同伴教育者从31赞比亚卫生设施，我们前瞻性地遵循脱离艾滋病毒患者回访诊所。我们使用Kaplan-Meier方法估计了累计复发率和复发时间。我们使用单变量和多变量考克斯比例风险回归进行风险因素分析，确定在社会生态框架的事件回报的预测因素。在556名脱离治疗的患者中，73.0% [95%置信区间（CI）：61.0至83.8]返回HIV护理。脱离的中位随访时间为32.3个月（四分位距：23.6-38.9）。脱离接触后，返回率随时间的延长而下降。事件返回的独立预测因素包括以前的护理差距[调整后的风险比（aHR）：1.95，95%CI：1.23至3.09]和在过去一年中遇到一次污名化者（aHR：2.14，95%CI：1.25至3.65）。与农村机构相比，如果患者从城市机构（aHR：0.68，95% CI：0.48至0.96）或医院（aHR：0.52，95% CI：0.33至0.82）寻求护理，则返回的可能性较小。需要采取干预措施，加快重新参与艾滋病毒护理。从脱离接触开始，按时间进行早期和有区别的干预，可以提高干预的有效性。城市和三级医疗机构的患者可能需要额外的支持。提高患者的复原力，在护理缺口后进行外展，以及减少社区耻辱感可能有助于返回。未来的再参与研究应包括已确定因素的因果关系评估。
Supplemental Digital Content is Available in the Text. Dynamic movement of patients in and out of HIV care is prevalent, but there is limited information on patterns of patient re-engagement or predictors of return to guide HIV programs to better support patient engagement. From a probability-based sample of lost to follow-up, adult patients traced by peer educators from 31 Zambian health facilities, we prospectively followed disengaged HIV patients for return clinic visits. We estimated the cumulative incidence of return and the time to return using Kaplan–Meier methods. We used univariate and multivariable Cox proportional hazards regression to conduct a risk factor analysis identifying predictors of incident return across a social ecological framework. Of the 556 disengaged patients, 73.0% [95% confidence interval (CI): 61.0 to 83.8] returned to HIV care. The median follow-up time from disengagement was 32.3 months (interquartile range: 23.6–38.9). The rate of return decreased with time postdisengagement. Independent predictors of incident return included a previous gap in care [adjusted Hazard Ratio (aHR): 1.95, 95% CI: 1.23 to 3.09] and confronting a stigmatizer once in the past year (aHR: 2.14, 95% CI: 1.25 to 3.65). Compared with a rural facility, patients were less likely to return if they sought care from an urban facility (aHR: 0.68, 95% CI: 0.48 to 0.96) or hospital (aHR: 0.52, 95% CI: 0.33 to 0.82). Interventions are needed to hasten re-engagement in HIV care. Early and differential interventions by time since disengagement may improve intervention effectiveness. Patients in urban and tertiary care settings may need additional support. Improving patient resilience, outreach after a care gap, and community stigma reduction may facilitate return. Future re-engagement research should include causal evaluation of identified factors.