Retention on ART and predictors of disengagement from care in several alternative community-centred ART refill models in rural Swaziland.
Retention on ART and predictors of disengagement from care in several alternative community-centred ART refill models in rural Swaziland.
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DOI：
10.1002/jia2.25183
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发表时间：
2018-09
影响因子：
6
通讯作者：
Kerschberger B
中科院分区：
文献类型：
--
作者：
Pasipamire L;Nesbitt RC;Ndlovu S;Sibanda G;Mamba S;Lukhele N;Pasipamire M;Kabore SM;Rusch B;Ciglenecki I;Kerschberger B
世界卫生组织为接受抗逆转录病毒治疗（ART）的稳定患者提出了广泛的以社区为中心的护理模式，以更好地应对患者需求，并减轻患者人数迅速增长对卫生系统造成的压力。在可行的情况下，除了常规临床护理外，通常还提供单一的替代护理模式。我们在一个公共部门环境中实施了几种以社区为中心的ART提供护理模式。在这里，我们比较保留在护理和ART，并确定脱离护理的预测因素。从2015年2月至2016年9月，在农村Shiselweni地区（斯威士兰），接受ART治疗的患者被纳入三个以社区为中心的ART提供护理模式：社区ART小组（CAG），综合外展护理和治疗俱乐部。我们使用Kaplan-Meier估计来描述护理模型中的粗略保留和ART保留（包括返回临床护理的患者）。使用多变量考克斯比例风险模型确定与全因护理模式和脱离ART相关的因素。共入组918例患者。CAG的参与者最多，有531人（57.8%）。中位年龄为44.7岁（IQR 36.3至54.4），71.8%的患者为女性，62.6%符合社区ART的合格标准。总体而言，ART的12个月保留率为93.7%;模型类型之间相似（p = 0.52）。相当比例的患者从社区ART返回临床护理，导致12个月的护理模式保留率较低（总体为82.2%）; CAG中的护理模式保留率最低，为70.4%，而外展为86.3%，治疗俱乐部为90.4%（p < 0.001）。在多变量考克斯回归模型中，与治疗俱乐部相比，CAG患者脱离护理模式的风险更高（aHR 3.15，95% CI 2.01至4.95，p < 0.001）。然而，我们发现，在替代模型类型之间，ART的磨损没有差异。在同一地区同时实施三种以社区为中心的替代性抗逆转录病毒治疗模式是可行的。虽然相当比例的患者返回临床护理，但总体ART保留率很高，应鼓励项目管理人员提供适合其特定环境的以社区为中心的护理模式。
A broad range of community‐centred care models for patients stable on anti‐retroviral therapy (ART) have been proposed by the World Health Organization to better respond to patient needs and alleviate pressure on health systems caused by rapidly growing patient numbers. Where available, often a single alternative care model is offered in addition to routine clinical care. We operationalized several community‐centred ART delivery care models in one public sector setting. Here, we compare retention in care and on ART and identify predictors of disengagement with care. Patients on ART were enrolled into three community‐centred ART delivery care models in the rural Shiselweni region (Swaziland), from 02/2015 to 09/2016: Community ART Groups (CAGs), comprehensive outreach care and treatment clubs. We used Kaplan–Meier estimates to describe crude retention in care model and retention on ART (including patients who returned to clinical care). Multivariate Cox proportional hazard models were used to determine factors associated with all‐cause attrition from care model and disengagement with ART. A total of 918 patients were enrolled. CAGs had the most participants with 531 (57.8%). Median age was 44.7 years (IQR 36.3 to 54.4), 71.8% of patients were female, and 62.6% fulfilled eligibility criteria for community ART. The 12‐month retention in ART was 93.7% overall; it was similar between model types (p = 0.52). A considerable proportion of patients returned from community ART to clinical care, resulting in lower 12 months retention in care model (82.2% overall); retention in care model was lowest in CAGs at 70.4%, compared with 86.3% in outreach and 90.4% in treatment clubs (p < 0.001). In multivariate Cox regression models, patients in CAGs had a higher risk of disengaging from care model (aHR 3.15, 95% CI 2.01 to 4.95, p < 0.001) compared with treatment clubs. We found, however, no difference in attrition in ART between alternative model types. Concurrent implementation of three alternative community‐centred ART models in the same region was feasible. Although a considerable proportion of patients returned back to clinical care, overall ART retention was high and should encourage programme managers to offer community‐centred care models adapted to their specific setting.
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DOI：
10.1111/tmi.12460
发表时间：
2015-04
期刊：
Tropical medicine & international health : TM & IH
影响因子：
--
作者：
Duncombe C;Rosenblum S;Hellmann N;Holmes C;Wilkinson L;Biot M;Bygrave H;Hoos D;Garnett G
通讯作者：
Garnett G
影响因子：
4.9
作者：
Posse, Mariana;Baltussen, Rob
通讯作者：
Baltussen, Rob
影响因子：
4.5
作者：
Rasschaert, Freya;Decroo, Tom;Van Damme, Wim
通讯作者：
Van Damme, Wim
影响因子：
3.7
作者：
Luque-Fernandez, Miguel Angel;Van Cutsem, Gilles;Boulle, Andrew
通讯作者：
Boulle, Andrew
DOI：
10.1080/13548506.2014.953962
发表时间：
2015
期刊：
Psychology, health & medicine
影响因子：
--
作者：
Dudhia R;Kagee A
通讯作者：
Kagee A