The Causal Effect of Tracing by Peer Health Workers on Return to Clinic Among Patients Who Were Lost to Follow-up From Antiretroviral Therapy in Eastern Africa: A "Natural Experiment" Arising From Surveillance of Lost Patients
The Causal Effect of Tracing by Peer Health Workers on Return to Clinic Among Patients Who Were Lost to Follow-up From Antiretroviral Therapy in Eastern Africa: A "Natural Experiment" Arising From Surveillance of Lost Patients
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DOI：
10.1093/cid/cix191
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发表时间：
2017-06-01
影响因子：
11.8
通讯作者：
Geng, Elvin H.
中科院分区：
文献类型：
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作者：
Bershetyn, Anna;Odeny, Thomas A.;Geng, Elvin H.
背景。追踪失去随访（LTFU）的人类免疫缺陷病毒（HIV）感染患者对再参与的影响尚未得到严格评估。我们对一项监测研究进行了事后分析，在该研究中，随机选择LTFU患者进行追踪，以确定追踪对再参与的影响。我们评估了在乌干达、肯尼亚和坦桑尼亚的14家诊所接受抗逆转录病毒治疗的hiv感染成人，他们是LTFU（最后一次就诊晚90天）。随机选择LTFU患者样本，由同伴卫生工作者进行追踪。我们使用Kaplan-Meier对所有患者以及存活的LTFU患者的再参与评估选择追踪的效果，这些患者通过示踪剂亲自接触，并且没有得到护理。在5781例符合条件的患者中，随机抽取991例（17%）进行追踪。选择追踪一年后，选择追踪的人中有13.3%（95%可信区间[CI]， 11.1%-15.3%）返回，而非随机选择的人中有10.0% （95% CI, 9.1%-10.8%）返回，调整后的风险差异为3.0% （95% CI, 0.7% -5.3%）。在被发现还活着、有过个人接触和失去护理的患者中，追踪使1年后复发的绝对概率增加了22% （95% CI, 7.1%-36.2%）。追踪对临床回复率的影响逐渐减弱，追踪后的半衰期为7.0天（95% CI, 2.6% -12.9%）。追踪干预措施增加了再参与，但开发针对LTFU患者最有可能受益的方法可以使这种做法更有效。
Background. The effect of tracing human immunodeficiency virus (HIV)-infected patients who are lost to follow-up (LTFU) on reengagement has not been rigorously assessed. We carried out an ex post analysis of a surveillance study in which LTFU patients were randomly selected for tracing to identify the effect of tracing on reengagement.Methods. We evaluated HIV-infected adults on antiretroviral therapy who were LTFU (>90 days late for last visit) at 14 clinics in Uganda, Kenya, and Tanzania. A random sample of LTFU patients was selected for tracing by peer health workers. We assessed the effect of selection for tracing using Kaplan-Meier estimates of reengagement among all patients as well as the subset of LTFU patients who were alive, contacted in person by the tracer, and out of care.Results. Of 5781 eligible patients, 991 (17%) were randomly selected for tracing. One year after selection for tracing, 13.3% (95% confidence interval [CI], 11.1%-15.3%) of those selected for tracing returned compared with 10.0% (95% CI, 9.1%-10.8%) of those not randomly selected, an adjusted risk difference of 3.0% (95% CI,.7%-5.3%). Among patients found to be alive, personally contacted, and out of care, tracing increased the absolute probability of return at 1 year by 22% (95% CI, 7.1%-36.2%). The effect of tracing on rate of return to clinic decayed with a half-life of 7.0 days after tracing (95% CI, 2.6 %-12.9%).Conclusions. Tracing interventions increase reengagement, but developing methods for targeting LTFU patients most likely to benefit can make this practice more efficient.