OBJECTIVES:We assessed retention and predictors of attrition (recorded death or loss to follow-up) in antiretroviral treatment (ART) clinics in Tanzania, Uganda and Zambia. METHODS:We conducted a retrospective cohort study among adults (≥18 years) starting ART during 2003-2010. We purposefully selected six health facilities per country and randomly selected 250 patients from each facility. Patients who visited clinics at least once during the 90 days before data abstraction were defined as retained. Data on individual and programme level risk factors for attrition were obtained through chart review and clinic manager interviews. Kaplan-Meier curves for retention across sites were created. Predictors of attrition were assessed using a multivariable Cox-proportional hazards model, adjusted for site-level clustering. RESULTS:From 17 facilities, 4147 patients were included. Retention ranged from 52.0% to 96.2% at 1 year to 25.8%-90.4% at 4 years. Multivariable analysis of ART initiation characteristics found the following independent risk factors for attrition: younger age [adjusted hazard ratio (aHR) and 95% confidence interval (95%CI) = 1.30 (1.14-1.47)], WHO stage 4 ([aHR (95% CI): 1.56 (1.29-1.88)], >10% bodyweight loss [aHR (95%CI) = 1.17 (1.00-1.38)], poor functional status [ambulatory aHR (95%CI) = 1.29 (1.09-1.54); bedridden aHR1.54 (1.15-2.07)], and increasing years of clinic operation prior to ART initiation in government facilities [aHR (95%CI) = 1.17 (1.10-1.23)]. Patients with higher CD4 cell count were less likely to experience attrition [aHR (95%CI) = 0.88 (0.78-1.00)] for every log (tenfold) increase. Sites offering community ART dispensing [aHR (95%CI) = 0.55 (0.30-1.01) for women; 0.40 (0.21-0.75) for men] had significantly less attrition. CONCLUSIONS:Patient retention to an individual programme worsened over time especially among males, younger persons and those with poor clinical indicators. Community ART drug dispensing programmes could improve retention.

译文

目的:我们评估了坦桑尼亚,乌干达和赞比亚的抗逆转录病毒治疗(ART)诊所的保留率和流失率(记录的死亡或随访损失)的预测因素。
方法:我们对2003-2010年开始接受ART的成年人(≥18岁)进行了一项回顾性队列研究。我们在每个国家有目的地选择了六个医疗机构,并从每个机构中随机选择了250名患者。在数据提取之前的90天内至少访问过一次诊所的患者被定义为保留。通过图表审查和诊所经理访谈获得了有关个人和计划级人员流失风险因素的数据。创建了跨站点保留的Kaplan-Meier曲线。使用多变量Cox比例风险模型评估损耗的预测因素,并针对站点级别的聚类进行了调整。
结果:来自17家机构的4147例患者被纳入研究。保留率从1年的52.0%至96.2%到4年的25.8%-90.4%不等。对ART起始特征的多变量分析发现以下几种导致流失的独立危险因素:年龄较小[调整后的危险比(aHR)和95%置信区间(95%CI)= 1.30(1.14-1.47)],WHO第4阶段([aHR( 95%CI):1.56(1.29-1.88),> 10%体重减轻[aHR(95%CI)= 1.17(1.00-1.38)],功能状态不佳[动态aHR(95%CI)= 1.29(1.09- 1.54);卧床不起的aHR1.54(1.15-2.07)],以及在政府机构开始抗逆转录病毒治疗之前临床工作的年限增加[aHR(95%CI)= 1.17(1.10-1.23)]。妇女提供社区抗逆转录病毒配药[aHR(95%CI)= 0.55(0.30-1.01)]的几率(增长10倍)减少[aHR(95%CI)= 0.88(0.78-1.00)]。男性则为0.40(0.21-0.75)]。
结论:随着时间的流逝,患者对单个程序的保留率随着时间的推移而恶化,尤其是在男性,年轻人和临床指标较差的人群中。社区抗逆转录病毒药物配药计划可以提高保留率。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录