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首页> 外文期刊>JAIDS: Journal of acquired immune deficiency syndromes >Time to Initiation of Antiretroviral Therapy Among Patients Who Are ART Eligible in Rwanda: Improvement Over Time
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Time to Initiation of Antiretroviral Therapy Among Patients Who Are ART Eligible in Rwanda: Improvement Over Time

机译:在卢旺达符合抗逆转录病毒治疗资格的患者中开始抗逆转录病毒治疗的时间:随着时间的推移而有所改善

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摘要

Background:Delayed initiation of antiretroviral therapy (ART) in eligible patients is a concern in resource-limited countries.Methods:We analyzed data on HIV-positive patients 15 years enrolled at 41 ICAP-supported health care facilities in Rwanda, 2005-2010, to determine time to ART initiation among patients eligible at enrollment compared with those ineligible or of indeterminate eligibility who become eligible during follow-up. ART eligibility was based on CD4(+) cell count (CD4(+)) and WHO staging; patients lacking CD4(+) and WHO stage were considered indeterminate. Cumulative incidence of reaching ART eligibility and to ART initiation after eligibility was generated using competing risk estimators.Results:A total of 31,033 ART-naive adults were enrolled; 64.2% were female. At enrollment, 10,158 (32.7%) patients were ART eligible, 13,372 (43.1%) were ineligible for ART, and 7503 (24.2%) patients were indeterminate. Among patients retained in care pre-ART eligibility, 17.9% [95% confidence interval (CI): 17.2 to 18.6] of ineligible and 22.8% (95% CI: 21.7 to 23.8) of indeterminate patients at enrollment reached ART eligibility within 12 months. Cumulative incidence of ART initiation within 3 months for patients eligible at enrollment was 77.2% (95% CI: 76.4 to 78.0) compared with 67.9% (95% CI: 66.4 to 69.3) for ineligible and 63.8% (95% CI: 61.9 to 65.8) for patients with indeterminate eligibility at enrollment (P < 0.05). Over the study period, there was more rapid ART initiation for patients who became ART eligible.Conclusions:We found higher rates of ART initiation within 3 months among patients who were ART eligible at enrollment compared with those who reached eligibility during follow-up. From 2006 to 2011, earlier initiation of ART after eligibility was observed likely reflecting improved program quality.
机译:背景:在资源有限的国家中,合格患者的抗逆转录病毒治疗(ART)延迟启动是一个令人关注的问题。方法:我们分析了2005-2010年在卢旺达由ICAP支持的41个医疗机构中15岁的HIV阳性患者的数据,以确定参加研究的合格患者与随访期间变得不合格的那些不合格或不确定的患者相比,开始抗病毒治疗的时间。 ART资格基于CD4(+)细胞计数(CD4(+))和WHO分期;缺乏CD4(+)和WHO分期的患者被认为是不确定的。结果:使用竞争性风险评估器得出达到ART资格和获得资格后开始ART的累积发生率。结果:总共招募了31,033名未接受过ART治疗的成年人; 64.2%是女性。入组时,有10,158名(32.7%)患者符合抗逆转录病毒治疗的资格,有13,372名(43.1%)不符合抗逆转录病毒治疗的资格,而7503名(24.2%)不确定的患者。在入组前保留ART资格的患者中,入选时不确定的患者中有17.9%[95%置信区间(CI):17.2至18.6]和22.8%(95%CI:21.7至23.8)在12个月内达到ART资格。符合入组条件的患者在3个月内开始ART的累计发生率为77.2%(95%CI:76.4至78.0),而不符合资格的患者为67.9%(95%CI:66.4至69.3)和63.8%(95%CI:61.9至91.9)。入选资格不确定的患者(65.8)(P <0.05)。在研究期间,符合ART资格的患者开始ART的速度更快。结论:与随访期间达到合格的患者相比,我们发现入选ART的患者在3个月内ART的发生率更高。从2006年到2011年,发现符合资格的ART提早开始,可能反映了计划质量的提高。

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