The cascade of HIV care among key populations in Indonesia: a prospective cohort study
The cascade of HIV care among key populations in Indonesia: a prospective cohort study
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DOI：
10.1016/s2352-3018(18)30148-6
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发表时间：
2018-10-01
期刊：
影响因子：
16.1
通讯作者：
Kaldor, John M.
中科院分区：
文献类型：
--
作者：
Januraga, Pande Putu;Reekie, Joanne;Kaldor, John M.
印度尼西亚对艾滋病毒检测和治疗的接受程度很低。我们做了一项研究来估计关键人群的HIV护理级联，并确定关键级联步骤的结果预测因子。方法采用观察性队列研究设计，在印度尼西亚巴厘岛、万隆、雅加达和日惹四个地点招募并随访男男性行为者（MSM）、女性性工作者、跨性别妇女（在印度尼西亚称为waria）和注射吸毒者（PWID）。招募、基线和随访是在合作临床服务机构进行的，包括初级保健站点和医院。参与者的纳入标准包括确定为关键人群的成员，年龄在16岁或以上，以前未检测出HIV阳性，以及基线时HIV阳性。所有参与者都按照国家指导方针接受治疗，并进行病毒载量测试和完成研究特定的测试。计算了与护理相关、开始治疗、坚持治疗和获得病毒学抑制的参与者的比例。我们使用逻辑回归来研究与抗逆转录病毒治疗（ART）开始和病毒抑制相关的特征，并使用Cox回归来确定与随访缺失相关的因素。本研究已在ClinicalTrials.gov注册，编号NCT03429842。在2015年9月15日至2016年9月30日期间，共有831人参与了该研究，其中包括637名（77%）男同性恋者，116名（14%）女性性工作者，27名（3%）女同性恋者和51名（6%）PWID患者。在入组的患者中，703人（84.6%,95% CI 82.1-87.1）与艾滋病毒治疗有关，606人（86.2%,83- 7-88- 8）与治疗开始时的抗逆转录病毒治疗有关。在开始治疗的参与者中，有457人（75.4%,71.8-78.9）留在护理中，其中325人（71.1%,66.7-75.2）在入组后约6个月进行了病毒载量检测，其中294人（90.5%,86.7-93.4）接受检测（294人[35%，32.1-38.7]为原始队列）病毒被抑制。606名开始治疗的患者中有146名（24%）失去了随访。在提供检测和治疗的站点注册的人比在只提供检测的站点注册的人有更高的开始治疗的可能性
Background Indonesia has had low uptake of HIV testing and treatment. We did a study to estimate the cascade of HIV care in key populations and identify predictors of outcomes at key cascade steps.Methods We used an observational cohort study design to recruit and follow up men who have sex with men (MSM), female sex workers, transgender women (known as waria in Indonesia), and people who inject drugs (PWID) diagnosed with HIV in four locations in Indonesia: Bali, Bandung, Jakarta, and Yogyakarta. Recruitment, baseline, and follow-up visits were done at collaborating clinical services, including both primary care sites and hospitals. Inclusion criteria for participants induded identifying as a member of a key population, age 16 years or older, not previously tested positive for HIV, and HIV positivity at baseline. All participants were offered treatment as per national guidelines, with the addition of viral load testing and completion of study-specific fonns. Estimates were calculated of proportions of participants linked to care, commencing treatment, adherent to treatment, and who achieved virological suppression. We used logistic regression to investigate characteristics associated with antiretroviral therapy (ART) initiation and viral suppression and Cox regression to identify factors associated with loss to follow-up. This study is registered with ClinicalTrials.gov , NCT03429842.Findings Between Sept 15, 2015, and Sept 30, 2016, 831 individuals were enrolled in the study, comprising 637 (77%) MSM, 116 (14%) female sex workers, 27 (3%) waria, and 51 (6%) PWID. Of those enrolled, 703 (84.6%, 95% CI 82.1-87.1) were linked to HIV care and 606 (86.2%, 83- 7-88- 8) who were linked with care started ART. Among participants who started treatment, 457 (75.4%, 71.8-78.9) were retained in care, of whom 325 (71.1%, 66.7-75.2) had a viral load test about 6 months after enrolment, with 294 (90.5%, 86.7-93.4) of those tested (294 [35%, 32.1-38.7] of the original cohort) virally suppressed. 146 (24%) of 606 who started treatment were lost to follow-up. People who enrolled at sites that offered both testing and treatment had a higher likelihood of treatment initiation than those who enrolled at sites offering testing only (p