Return to normal life after AIDS as a reason for lost to follow-up in a community-based antiretroviral treatment program.
Return to normal life after AIDS as a reason for lost to follow-up in a community-based antiretroviral treatment program.
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DOI：
10.1097/ftd.0b013e3182526e6a
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发表时间：
2012-06-01
期刊：
影响因子：
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通讯作者：
Laga M
中科院分区：
文献类型：
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作者：
Alamo ST;Colebunders R;Ouma J;Sunday P;Wagner G;Wabwire-Mangen F;Laga M
了解乌干达社区抗逆转录病毒治疗项目失访（LTFU）的原因。对2001年5月31日至2010年5月31日期间的LTFU患者进行了回顾性队列检查。对579名患者的代表性样本进行追踪，以确定其结局。使用了混合方法。使用“停止护理”作为危险，“自我转移”作为比较，我们使用考克斯比例多变量模型的风险因素停止护理。总体而言，3954例患者中有2933例（74.0%）为LTFU。在2933例（19%）采样追踪的患者中，32例（5.5%）无法追踪，66例（11.4%）死亡，481例（83.0%）存活。在被发现活着的人中，232人（40.0%）停止了护理，249人（43.0%）自行转移，而61人（12.7%）返回到姆布亚艾滋病毒/艾滋病伸出援助倡议的护理。在调整后的风险比中，来自坎帕拉以外的宗教信仰、在坎帕拉居住<5 years but >1年、有学龄儿童失学、未披露艾滋病毒、CD 4计数>250个细胞/立方毫米和预先抗逆转录病毒治疗与停止治疗的风险增加有关。定性访谈显示，恢复正常生活是LTFU的一个关键原因。在61名重返护理的患者中，LTFU时的中位CD 4计数高于重返护理时（401/mm 3 vs. 205/mm 3，P < 0.0001）。许多患者在数年内成为LTFU，因此需要有效的机制来识别需要密切监测的患者。应努力改进转诊和跟踪转到不同设施的病人的机制。此外，需要追踪成为LTFU的患者，以说服他们返回。
To understand reasons for lost-to-follow-up (LTFU) from a community-based antiretroviral therapy program in Uganda. Retrospective cohort of patients LTFU between May 31, 2001, to May 31, 2010, was examined. A representative sample of 579 patients traced to ascertain their outcomes. Mixed methods were used. Using “stopped care” as the hazard and “self-transferred” as the comparator, we examined using Cox proportional multivariable model risk factors for stopping care. Overall, 2933 of 3954 (74.0%) patients were LTFU. Of 579 of 2933 (19%) patients sampled for tracing, 32 (5.5%) were untraceable, 66(11.4 %) were dead, and 481 (83.0%) found alive. Of those found alive, 232 (40.0%) stopped care, 249 (43.0%) self-transferred, whereas 61 (12.7%) returned to care at Reach Out Mbuya HIV/AIDS Initiative. In adjusted hazards ratios, born-again religion, originating from outside Kampala, resident in Kampala for <5 years but >1 year, having school-age children who were out of school, non-HIV disclosure, CD4 counts >250 cells per cubic millimeter and pre–antiretroviral therapy were associated with increased risk of stopping care. Qualitative interviews revealed return to a normal life as a key reason for LTFU.Of 61 patients who returned to care, their median CD4 count at LTFU was higher than on return into care (401/mm3 vs. 205/mm3, P < 0.0001). Many patients become LTFU during the course of years, necessitating the need for effective mechanisms to identify those in need of close monitoring. Efforts should be made to improve referrals and mechanisms to track patients who transfer to different facilities. Additionally, tracing of patients who become LTFU is required to convince them to return.