Outcomes of stable HIV-positive patients down-referred from a doctor-managed antiretroviral therapy clinic to a nurse-managed primary health clinic for monitoring and treatment.
Outcomes of stable HIV-positive patients down-referred from a doctor-managed antiretroviral therapy clinic to a nurse-managed primary health clinic for monitoring and treatment.
复制标题
DOI：
10.1097/qad.0b013e32834b6480
复制
发表时间：
2011-10-23
期刊：
影响因子：
--
通讯作者：
Fox MP
中科院分区：
文献类型：
--
作者：
Brennan AT;Long L;Maskew M;Sanne I;Jaffray I;MacPhail P;Fox MP
将转诊至护士管理的初级卫生保健诊所（PHC）进行治疗维持的稳定HIV阳性患者（DR）与留在医生管理的治疗起始地点（TI）的患者的临床、免疫学和病毒学结局进行比较。我们在南非约翰内斯堡Themba Lethu诊所的稳定HIV患者中进行了匹配队列分析。符合条件的患者符合向下转诊的标准（检测不到病毒载量<10个月，ART >11个月，CD 4 ≥ 200个细胞/mm 3，体重稳定，无机会性感染），无论他们是否在2008年2月至2009年1月期间向下转诊到PHC进行治疗维持。使用倾向评分将患者1：3（DR：TI）匹配。我们计算了12个月随访时下转诊对失访（LTFU）和死亡率的影响的发生率和风险比，以及下转诊对病毒反弹的相对风险。693例DR患者与2079例TI患者相匹配。2例（0.3%）DR和32例（1.5%）TI患者死亡，10例（1.4%）DR和87例（4.2%）TI丢失，而22例（3.3%）DR和100例（5.6%）TI在12个月随访时出现病毒反弹。调整后，随访期间，与TI患者相比，下转介患者死亡（HR 0.2; 95%CI：0.04-0.8）、LTFU（HR 0.3; 95%CI：0.2-0.6）或病毒反弹（RR 0.6; 95%CI 0.4-0.9）的可能性更低。利用护士管理的初级保健中心对稳定患者进行治疗维持可以减轻专业医生管理的ART诊所的负担。在PHCs的DR患者的患者结局似乎与稳定患者在ART诊所获得的结局相同，如果不是更好的话。
Compare clinical, immunologic and virologic outcomes amongst stable HIV-positive patients down-referred (DR) to nurse-managed primary health care clinic (PHC) for treatment maintenance to those who remained at the doctor-managed treatment-initiation site (TI). We conducted a matched cohort analysis amongst stable HIV patients at the Themba Lethu Clinic, in Johannesburg, South Africa. Eligible patients met the criteria for down-referral (undetectable viral load <10-months, ART >11-months, CD4 ≥200cells/mm3, stable weight and no opportunistic infections) regardless of whether they were down-referred to a PHC for treatment maintenance between February 2008-January 2009. Patients were matched 1:3 (DR:TI) using propensity scores. We calculated rates and hazard ratios for the effect of down-referral on loss to follow-up (LTFU) and mortality and the relative risk of down-referral on viral rebound by 12-months of follow-up. 693 DR patients were matched to 2079 TI patients. Two (0.3%) DR and 32 (1.5%) TI patients died, 10 (1.4%) DR and 87 (4.2%) TI were lost, while 22 (3.3%) DR and 100 (5.6%) TI experience viral rebound by 12-months of follow-up. After adjustment, patients down-referred were less likely to die (HR 0.2; 95%CI: 0.04-0.8), become LTFU (HR 0.3; 95%CI: 0.2-0.6) or experience viral rebound (RR 0.6; 95%CI 0.4-0.9) than TI patients during follow-up. The utilization of nurse-managed PHCs for treatment maintenance of stable patients could decrease the burden on specialized doctor-managed ART clinics. Patient outcomes for DR patients at PHCs appear equal, if not better, than those achieved at ART clinics amongst stable patients.