Use of a Comprehensive HIV Care Cascade for Evaluating HIV Program Performance: Findings From 4 Sub-Saharan African Countries.
Use of a Comprehensive HIV Care Cascade for Evaluating HIV Program Performance: Findings From 4 Sub-Saharan African Countries.
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DOI：
10.1097/qai.0000000000000745
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发表时间：
2015-10-01
期刊：
影响因子：
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通讯作者：
Identifying Optimal Models of HIV Care and Treatment in Sub-Saharan Africa Study
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文献类型：
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作者：
McNairy ML;Lamb MR;Abrams EJ;Elul B;Sahabo R;Hawken MP;Mussa A;Zwede A;Justman J;El-Sadr WM;Identifying Optimal Models of HIV Care and Treatment in Sub-Saharan Africa Study
人们注意到，传统的艾滋病毒治疗级联有其局限性。一个拟议的全面艾滋病毒护理级联，使用队列方法提供了额外的信息，因为它占所有患者。使用来自4个国家的数据，我们比较了使用两种方法的患者结局。研究纳入了2005年至2011年在肯尼亚、莫桑比克、卢旺达和坦桑尼亚的217个设施登记的390，603名艾滋病毒感染成年人（>15岁）的数据。所有患者在入组后3、6和12个月的结局被分类为最佳、次佳或较差。最佳结果包括保留护理，抗逆转录病毒治疗（ART）的开始，并记录转移。次优结局包括合格患者或无合格数据的患者在未开始ART的情况下继续接受护理。不良结局包括失访和死亡。全面的艾滋病毒护理级联表明，在3个月、6个月和12个月时，58%、51%和49%的患者具有最佳结局; 22%、12%和7%的患者具有次佳结局，20%、37%和44%的患者具有较差结局。在所有入组的患者中，56%的患者在入组后12个月仍接受护理。相比之下，传统的艾滋病毒治疗级联发现，89%的艾滋病毒护理患者接受了ART资格评估，其中48%被确定为ART资格，70%开始接受ART，78%开始接受ART的患者在12个月后保留。全面的艾滋病毒护理级联遵循所有患者的结果，包括ART前患者，他们随着时间的推移参加了艾滋病毒护理，并使用护理质量参数对结果进行分类。综合艾滋病毒护理级联提供了传统艾滋病毒治疗级联的补充信息，是监测艾滋病毒方案绩效的宝贵工具。
The traditional HIV treatment cascade has been noted to have limitations. A proposed comprehensive HIV care cascade that uses cohort methodology offers additional information as it accounts for all patients. Using data from 4 countries, we compare patient outcomes using both approaches. Data from 390,603 HIV-infected adults (>15 years) enrolled at 217 facilities in Kenya, Mozambique, Rwanda, and Tanzania from 2005 to 2011 were included. Outcomes of all patients at 3, 6, and 12 months after enrollment were categorized as optimal, suboptimal, or poor. Optimal outcomes included retention in care, antiretroviral therapy (ART) initiation, and documented transfer. Suboptimal outcomes included retention in care without ART initiation among eligible patients or those without eligibility data. Poor outcomes included loss to follow-up and death. The comprehensive HIV care cascade demonstrated that at 3, 6 and 12 months, 58%, 51%, and 49% of patients had optimal outcomes; 22%, 12%, and 7% had suboptimal outcomes, and 20%, 37% and 44% had poor outcomes. Of all patients enrolled in care, 56% were retained in care at 12 months after enrollment. In comparison, the traditional HIV treatment cascade found 89% of patients enrolled in HIV care were assessed for ART eligibility, of whom 48% were determined to be ART-eligible with 70% initiating ART, and 78% of those initiated on ART retained at 12 months. The comprehensive HIV care cascade follows outcomes of all patients, including pre-ART patients, who enroll in HIV care over time and uses quality of care parameters for categorizing outcomes. The comprehensive HIV care cascade provides complementary information to that of the traditional HIV treatment cascade and is a valuable tool for monitoring HIV program performance.