Factors associated with antiretroviral treatment initiation amongst HIV-positive individuals linked to care within a universal test and treat programme: early findings of the ANRS 12249 TasP trial in rural South Africa.
Factors associated with antiretroviral treatment initiation amongst HIV-positive individuals linked to care within a universal test and treat programme: early findings of the ANRS 12249 TasP trial in rural South Africa.
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DOI：
10.1080/09540121.2016.1164808
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发表时间：
2016
期刊：
影响因子：
1.7
通讯作者：
ANRS 12249 TasP study group
中科院分区：
文献类型：
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作者：
Boyer S;Iwuji C;Gosset A;Protopopescu C;Okesola N;Plazy M;Spire B;Orne-Gliemann J;McGrath N;Pillay D;Dabis F;Larmarange J;ANRS 12249 TasP study group
迅速接受抗逆转录病毒治疗对于确保普遍检测和治疗战略在高流行率环境中预防艾滋病毒传播至关重要。我们描述了在南非农村正在进行的UTT随机分组试验中的ART启动率和相关因素。在干预组中，HIV阳性个体立即接受ART治疗，而在对照组中，国家指南建议启动ART治疗（CD 4 ≤350个细胞/mm 3）。我们使用了截至2015年7月在2015年1月之前与TasP诊所有联系的ART合格个体中收集的数据。按照聚类和CD 4计数分层（细胞/mm 3）和其他合格标准描述基线访视后1个月（M1）、3个月（M3）和6个月（M6）的ART启动率：≤100; 100-200; 200-350; CD 4>350伴WHO 3/4期或妊娠; CD 4>350不伴WHO 3/4期或妊娠。解释协变量效应随时间变化的考克斯模型用于评估与ART启动相关的因素。514名参与者的中位[四分位距]随访持续时间为1.08 [0.69; 2.07]个月，直至ART开始或末次访视。M1时的ART启动率差异很大（CD 4>350组中36.9%，无WHO 3/4期或妊娠，CD 4 ≤350的三组中55.2-71.8%），但M6时的启动率较小（从第一组的85.3%到其他三组的96.1-98.3%）。与M1时较低的抗逆转录病毒疗法启动率相关的因素是较高的CD 4计数和就诊的诊所患者量高和较高的聚集性艾滋病毒流行率。M1之后，拥有固定伴侣是与ART启动可能性较高相关的唯一因素。这些发现表明，在UTT环境中，即使在CD 4计数高的个体中，ART吸收也很好。然而，人员配备不足和医疗保健专业人员的做法可能会导致优先考虑在CD 4计数最低的患者中启动ART。
Prompt uptake of antiretroviral treatment (ART) is essential to ensure the success of universal test and treat (UTT) strategies to prevent HIV transmission in high-prevalence settings. We describe ART initiation rates and associated factors within an ongoing UTT cluster-randomized trial in rural South Africa. HIV-positive individuals were offered immediate ART in the intervention arm vs. national guidelines recommended initiation (CD4≤350 cells/mm3) in the control arm. We used data collected up to July 2015 among the ART-eligible individuals linked to TasP clinics before January 2015. ART initiation rates at one (M1), three (M3) and six months (M6) from baseline visit were described by cluster and CD4 count strata (cells/mm3) and other eligibility criteria: ≤100; 100–200; 200–350; CD4>350 with WHO stage 3/4 or pregnancy; CD4>350 without WHO stage 3/4 or pregnancy. A Cox model accounting for covariate effect changes over time was used to assess factors associated with ART initiation. The 514 participants had a median [interquartile range] follow-up duration of 1.08 [0.69; 2.07] months until ART initiation or last visit. ART initiation rates at M1 varied substantially (36.9% in the group CD4>350 without WHO stage 3/4 or pregnancy, and 55.2–71.8% in the three groups with CD4≤350) but less at M6 (from 85.3% in the first group to 96.1–98.3% in the three other groups). Factors associated with lower ART initiation at M1 were a higher CD4 count and attending clinics with both high patient load and higher cluster HIV prevalence. After M1, having a regular partner was the only factor associated with higher likelihood of ART initiation. These findings suggest good ART uptake within a UTT setting, even among individuals with high CD4 count. However, inadequate staffing and healthcare professional practices could result in prioritizing ART initiation in patients with the lowest CD4 counts.
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DOI：
10.1111/tmi.12460
发表时间：
2015-04
期刊：
Tropical medicine & international health : TM & IH
影响因子：
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作者：
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Identifying Optimal Models of HIV Care and Treatment in Sub-Saharan Africa Study
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DOI：
10.1097/qad.0b013e32834b6464
发表时间：
2011-11-13
期刊：
AIDS (London, England)
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