Expansion and scale-up of HIV care and treatment services in four countries over ten years

BackgroundScale-up and expansion of antiretroviral therapy (ART) for people living with HIV (PLHIV) have been a global priority for more than 15 years.MethodsWe describe PLHIV at enrollment in care and ART initiation in Ethiopia, Kenya, Mozambique and Tanzania from 2005–2014 and report on enrollment location, CD4 count and loss to follow-up (LTF), death, and combined attrition (LTF and death) pre- and post-ART initiation over time. Pre-ART outcomes were estimated using competing risk and post-ART using Kaplan-Meier estimators; LTF defined as no visit within six months pre-ART and 12 months after ART start.ResultsFrom 2005–2014, 884,328 PLHIV enrolled in care at 350 health facilities, median age was 32.0 years (interquartile range [IQR] 26.0–42.0), and majority were female (66.5%). The proportion of PLHIV enrolled at primary and rural facilities increased from 12.9% and 15.3% in 2005–2006 to 43.5% and 41.7% in 2013–2014 (p3 in 2005–2006 (IQR 71–339) to 289 cell/mm3 in 2013–2014 (IQR 133–485) (pConclusionOver 10 years of HIV scale-up in four sub-Saharan African countries, close to a million PLHIV were enrolled in care increasingly at rural and primary facilities with increasing CD4 count. Loss to follow-up from HIV care remains alarmingly high, particularly among pregnant women and younger PLHIV.

研究背景：十五余年来，为人类免疫缺陷病毒感染者（People Living With HIV, PLHIV）扩大抗反转录病毒治疗（Antiretroviral Therapy, ART）的覆盖范围与可及性，始终是全球公共卫生的核心优先事项。
研究方法：本研究对2005年至2014年间，在埃塞俄比亚、肯尼亚、莫桑比克及坦桑尼亚入组护理并启动抗反转录病毒治疗的人类免疫缺陷病毒感染者进行描述，记录其入组地点、CD4细胞计数，以及抗反转录病毒治疗启动前后的失访（Loss to Follow-Up, LTF）、死亡及复合脱落（失访与死亡）情况随时间的变化趋势。本研究采用竞争风险模型估算抗反转录病毒治疗前的临床结局，采用Kaplan-Meier估计法分析治疗后结局；失访定义为抗反转录病毒治疗前6个月内及治疗启动后12个月内无任何就诊记录。
研究结果：2005年至2014年间，共计884328例人类免疫缺陷病毒感染者在350家医疗机构入组护理，其中位年龄为32.0岁（四分位间距[IQR] 26.0~42.0），大多数为女性（66.5%）。在基层医疗机构与农村医疗机构入组的感染者比例，从2005-2006年的12.9%和15.3%，分别提升至2013-2014年的43.5%和41.7%（原文此处统计检验信息不完整）。入组时的CD4细胞计数中位数从2005-2006年的[原文数据缺失]（四分位间距71~339）升至2013-2014年的289个/立方毫米（四分位间距133~485）（原文此处统计检验信息不完整）。
研究结论：在撒哈拉以南非洲四国开展的十余年人类免疫缺陷病毒治疗扩面工作中，近百万人类免疫缺陷病毒感染者逐渐转向基层及农村医疗机构入组护理，且入组时的CD4细胞计数呈上升趋势。但人类免疫缺陷病毒护理过程中的失访率仍处于令人担忧的高位，尤其在孕妇及年轻感染者群体中更为显著。