Eligibility for differentiated models of HIV treatment service delivery: an estimate from Malawi and Zambia
Eligibility for differentiated models of HIV treatment service delivery: an estimate from Malawi and Zambia
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DOI：
10.1097/qad.0000000000002435
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发表时间：
2020-03-01
期刊：
影响因子：
3.8
通讯作者：
Rosen, Sydney
中科院分区：
文献类型：
--
作者：
Hoffman, Risa M.;Balakasi, Kelvin;Rosen, Sydney
背景资料：人们对接受抗逆转录病毒治疗（ART）的艾滋病毒阳性患者中符合差异化服务提供（DSD）模式稳定性标准的比例知之甚少。我们报告的比例ART客户满足稳定性标准的一部分，在马拉维和赞比亚的一个多月配药的随机试验筛选。研究方法：对于目前正在进行的DSD试验，我们在马拉维和赞比亚的30个成人ART诊所筛选了至少18岁的HIV阳性患者，以确定是否符合DSD的条件。稳定性定义为一线ART（依法韦仑/替诺福韦/拉米夫定）至少6个月，无ART副作用，无毒性或感染性并发症，ART诊所未治疗非传染性疾病，在前6个月内ART依从性无缺失（>30天未接受ART），并且如果是女性，则未妊娠或哺乳。结果：2017年5月10日至2018年4月30日期间，共接触了3465名成人ART客户（马拉维：1680;赞比亚：1785）。在回答筛选问题的2938人中（马拉维：1527人;赞比亚：1411人），2173人（73.5%）符合DSD资格标准（马拉维：72.8%;赞比亚：74.3%）。不合格的最常见原因是接受ART不到6个月（9.6%）和标准一线治疗以外的治疗方案（7.9%）。结论：在马拉维和赞比亚的抗逆转录病毒疗法诊所，大约四分之三的成年客户有资格使用典型的稳定性定义进行DSD。符合条件的客户对DSD模式的高度采用将对基础设施和艾滋病毒治疗资源的分配产生重大影响。
Background: Little is known about the proportion of HIV-positive clients on antiretroviral therapy (ART) who meet stability criteria for differentiated service delivery (DSD) models. We report the proportion of ART clients meeting stability criteria as part of screening for a randomized trial of multimonth dispensing in Malawi and Zambia. Methods: For a DSD trial now underway, we screened HIV-positive clients aged at least 18 years presenting for HIV treatment in 30 adult ART clinics in Malawi and Zambia to determine eligibility for DSD. Stability was defined as on first-line ART (efavirenz/tenofovir/lamivudine) for at least 6 months, no ART side effects, no toxicity or infectious complications, no noncommunicable diseases being treated in ART clinic, no lapses in ART adherence in the prior 6 months (>30 days without taking ART), and if female, not pregnant or breastfeeding. Results: In total, 3465 adult ART clients were approached between 10 May 2017 and 30 April 2018 (Malawi: 1680; Zambia: 1785). Of the 2938 who answered screening questions (Malawi: 1527; Zambia: 1411), 2173 (73.5%) met criteria for DSD eligibility (Malawi: 72.8%; Zambia: 74.3%). The most common reasons for ineligibility were being on ART less than 6 months (9.6%) and a regimen other than standard first-line (7.9%). Conclusion: Approximately three-quarters of all adult clients presenting at ART clinics in Malawi and Zambia were eligible for DSD using a typical definition of stability. High uptake of DSD models by eligible clients would have a major impact on the infrastructure and the allocation of HIV treatment resources.