Characteristics and outcomes of adult Ethiopian patients enrolled in HIV care and treatment: a multi-clinic observational study.
Characteristics and outcomes of adult Ethiopian patients enrolled in HIV care and treatment: a multi-clinic observational study.
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DOI：
10.1186/s12889-015-1776-4
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发表时间：
2015-05-03
影响因子：
4.5
通讯作者：
Abrams EJ
中科院分区：
文献类型：
--
作者：
Melaku Z;Lamb MR;Wang C;Lulseged S;Gadisa T;Ahmed S;Habtamu Z;Alemu H;Assefa T;Abrams EJ
我们描述了2006-2011年埃塞俄比亚开始艾滋病毒护理和治疗的成年人的特征和结果的趋势。我们对2006-2011年在56家埃塞俄比亚卫生机构登记的艾滋病毒阳性成人（≥15岁）进行了回顾性纵向分析。我们调查了通过提供者发起的咨询和检测（PITC）登记的比例、基线CD 4+细胞计数和WHO分期随时间的趋势。此外，我们评估了ART启动前后的结局（记录的死亡、失访（LTF）、转移和总损耗（记录的死亡加上LTF））。Kaplan-Meier技术估计了ART开始后36个月内这些结局的累积发生率。使用考虑诊所内相关性的风险比估计与ART启动后LTF和死亡相关的因素。93，418名成年人登记接受艾滋病毒护理; 53，300人（57%）开始接受抗逆转录病毒治疗。通过PITC登记的比例从27.6%（2006-2007年）增加到44.8%（2010-2011年）（p < .0001）。同时，入组的中位CD 4+细胞计数从158个细胞/mm 3增加到208个细胞/mm 3（p < .0001），接受ART治疗的晚期WHO分期患者从2006-2007年的56.6%（III期）和15.0%（IV期）下降到2010-2011年的47.6%（III期）和8.5%（IV期）。ART开始时的中位CD 4+细胞计数随时间保持稳定。24%的患者在ART开始前为LTF。在开始ART的患者中，36个月后的流失率为30%，大多数发生在前6个月内。ART开始后记录的死亡率在6个月和36个月分别为6.4%和9.2%，并随时间推移而下降。年轻、男性、从未结婚、未接受过正规教育、CD 4+细胞计数低和WHO分期高与LTF增加相关。记录的死亡率在年轻人、女性、已婚者、CD 4+细胞计数较高者和开始抗逆转录病毒治疗时WHO分期较低者中较低。随着时间的推移，通过门诊PITC接受艾滋病毒护理的人数增加，患者在所有艾滋病毒检测点的早期疾病阶段接受艾滋病毒护理。然而，ART开始时的中位CD 4+细胞计数保持稳定。抗逆转录病毒治疗前和治疗后的自然减员（特别是在前6个月）仍然是确保及时开始抗逆转录病毒治疗和保留抗逆转录病毒治疗的主要挑战。
We describe trends in characteristics and outcomes among adults initiating HIV care and treatment in Ethiopia from 2006-2011. We conducted a retrospective longitudinal analysis of HIV-positive adults (≥15 years) enrolling at 56 Ethiopian health facilities from 2006–2011. We investigated trends over time in the proportion enrolling through provider-initiated counseling and testing (PITC), baseline CD4+ cell counts and WHO stage. Additionally, we assessed outcomes (recorded death, loss to follow-up (LTF), transfer, and total attrition (recorded death plus LTF)) before and after ART initiation. Kaplan-Meier techniques estimated cumulative incidence of these outcomes through 36 months after ART initiation. Factors associated with LTF and death after ART initiation were estimated using Hazard Ratios accounting for within-clinic correlation. 93,418 adults enrolled into HIV care; 53,300 (57%) initiated ART. The proportion enrolled through PITC increased from 27.6% (2006–2007) to 44.8% (2010–2011) (p < .0001). Concurrently, median enrollment CD4+ cell count increased from 158 to 208 cells/mm3 (p < .0001), and patients initiating ART with advanced WHO stage decreased from 56.6% (stage III) and 15.0% (IV) in 2006–2007 to 47.6% (stage III) and 8.5% (IV) in 2010–2011. Median CD4+ cell count at ART initiation remained stable over time. 24% of patients were LTF before ART initiation. Among those initiating ART, attrition was 30% after 36 months, with most occurring within the first 6 months. Recorded death after ART initiation was 6.4% and 9.2% at 6 and 36 months, respectively, and decreased over time. Younger age, male gender, never being married, no formal education, low CD4+ cell count, and advanced WHO stage were associated with increased LTF. Recorded death was lower among younger adults, females, married individuals, those with higher CD4+ cell counts and lower WHO stage at ART initiation. Over time, enrollment in HIV care through outpatient PITC increased and patients enrolled into HIV care at earlier disease stages across all HIV testing points. However, median CD4+ cell count at ART initiation remained steady. Pre- and post-ART attrition (particularly in the first 6 months) have remained major challenges in ensuring prompt ART initiation and retention on ART.
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DOI：
10.1097/qai.0b013e3182075ae2
发表时间：
2011-03-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Lessells RJ;Mutevedzi PC;Cooke GS;Newell ML
通讯作者：
Newell ML
DOI：
10.1097/qai.0b013e3181b843f0
发表时间：
2010-03
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Geng EH;Bangsberg DR;Musinguzi N;Emenyonu N;Bwana MB;Yiannoutsos CT;Glidden DV;Deeks SG;Martin JN
通讯作者：
Martin JN
DOI：
10.2471/blt.07.044248
发表时间：
2008-07-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Brinkhof, Martin WG;Dabis, François;Anglaret, Xavier
通讯作者：
Anglaret, Xavier
DOI：
10.1111/j.1365-3156.2011.02889.x
发表时间：
2012-01
期刊：
Tropical medicine & international health : TM & IH
影响因子：
--
作者：
Hassan AS;Fielding KL;Thuo NM;Nabwera HM;Sanders EJ;Berkley JA
通讯作者：
Berkley JA
2006年2月至12月之间，埃塞俄比亚抗逆转录病毒治疗的利用：空间，时间和人口统计学模式。
影响因子：
4.9
作者：
Kloos, Helmut;Assefa, Yibeltal;Adugna, Aynalem;Mulatu, Mesfin Samuel;Mariam, Damen Haile
通讯作者：
Mariam, Damen Haile