Mobility and Clinic Switching Among Postpartum Women Considered Lost to HIV Care in South Africa.
Mobility and Clinic Switching Among Postpartum Women Considered Lost to HIV Care in South Africa.
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DOI：
10.1097/qai.0000000000001284
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发表时间：
2017-04-01
期刊：
影响因子：
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通讯作者：
Fox MP
中科院分区：
文献类型：
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作者：
Clouse K;Vermund SH;Maskew M;Lurie MN;MacLeod W;Malete G;Carmona S;Sherman G;Fox MP
坚持艾滋病毒护理，特别是产后妇女，是国家抗逆转录病毒治疗（ART）计划面临的挑战。由于未报告的转移，保留估计可能被低估。我们探讨了失随访患者（LTFU）的流动性和诊所转换。观察性队列研究。在南非约翰内斯堡6家公立诊所的788名怀孕期间开始抗逆转录病毒治疗的妇女中，300名（38.1%）是LTFU（未就诊≥3个月）。我们在南非国家卫生实验室服务数据库中手动搜索这些妇女，以评估艾滋病毒护理的连续性。我们使用地理信息系统工具来绘制交通到新设施的地图。超过三分之一（37.6%）的妇女在LTFU后继续接受艾滋病毒治疗。其中，67.0%的患者在原诊所所在省份继续接受治疗。与那些在省外旅行的人相比，这些同省的“诊所购物者”在护理之外停留的时间更长[中位数373天（IQR: 175-790） vs. 175.5天（IQR: 74-371）]，并且在重新进入时CD4+细胞计数较低[中位数327细胞/µL (IQR: 196-576) vs. 493细胞/µL （IQR: 213-557）。当考虑所有有额外护理证据的妇女参与护理时，队列LTFU从38.1%下降到25.0%。我们发现了LTFU后继续护理的证据，并确定了当地和全国产后妇女的临床流动性。实验室记录不能显示所有的门诊就诊，人工匹配可能被低估或高估。有必要建立一个与唯一标识符相联系的国家卫生数据库，以改善高流动性人口的报告和病人护理。
Retention in HIV care, particularly among postpartum women, is a challenge to national antiretroviral therapy (ART) programs. Retention estimates may be underestimated due to unreported transfers. We explored mobility and clinic switching among patients considered lost to follow-up (LTFU). Observational cohort study. Of 788 women initiating ART during pregnancy at six public clinics in Johannesburg, South Africa, 300 (38.1%) were LTFU (no visit ≥3 months). We manually searched for these women in the South African National Health Laboratory Services database to assess continuity of HIV care. We used geographic information systems tools to map mobility to new facilities. Over one–third (37.6%) of women showed evidence of continued HIV care after LTFU. Of these, 67.0% continued care in the same province as the origin clinic. Compared to those who traveled outside of the province for care, these same-province “clinic shoppers” stayed out-of-care longer [median 373 days (IQR: 175–790) vs. 175.5 days (IQR: 74–371)] and had a lower CD4+ cell count upon re-entry [median 327 cells/µL (IQR: 196–576) vs. 493 cells/µL (IQR: 213–557). When considering all women with additional evidence of care as engaged in care, cohort LTFU dropped from 38.1% to 25.0%. We found evidence of continued care after LTFU and identified local and national clinic mobility among postpartum women. Laboratory records do not show all clinic visits and manual matching may have been under- or overestimated. A national health database linked to a unique identifier is necessary to improve reporting and patient care among highly mobile populations.