Barriers to longitudinal follow-up for hepatitis B treatment in rural Sierra Leone: A mixed methods study of retention in care.

Clinical Liver Disease Pub Date : 2024-05-31 eCollection Date: 2024-01-01 DOI:10.1097/CLD.0000000000000225
Williams Lebbie, Lao-Tzu Allan-Blitz, Emmanuel T Nyama, Mohamed Swaray, Daniel Lavalie, Michael Mhango, Marta Patiño Rodriguez, Neil Gupta, Remy Bitwayiki
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Abstract

HBV disproportionately affects resource-limited settings, and retaining patients in longitudinal care remains challenging. We conducted a mixed methods investigation to understand the causes of losses to follow-up within an HBV clinic in rural Sierra Leone. We developed a multivariable logistic regression model of baseline clinical and sociodemographic factors predicting losses to follow-up, defined as failing to present for a follow-up visit within 14 months of enrollment. We included patients enrolled between April 30, 2019 and March 1, 2020, permitting 14 months of follow-up by April 30, 2021. We then developed a survey to solicit patient perspectives on the challenges surrounding retention. We interviewed randomly selected patients absent from HBV care for at least 6 months. Among 271 patients enrolled in the Kono HBV clinic, 176 (64.9%) did not have a follow-up visit within 14 months of the study end point. Incomplete baseline workup (aOR 2.9; 95% CI: 1.6-4.8), lack of treatment at baseline (aOR 5.0; 95% CI: 1.7-14.4), and having cirrhosis at baseline (aOR 3.3; 95% CI: 0.99-10.8) were independently associated with being lost to follow-up. For the patient survey, 21 patients completed the interview (median age 34 years [IQR: 25-38]). Travel-related factors were the most frequently reported barrier to retention (57%). Almost 30% suggested improved customer care might support retention in care; 24% requested to be given medication. In our setting, factors that might reduce losses to follow-up included expanded criteria for treatment initiation, overcoming transportation barriers, reducing wait times, ensuring against stockouts, and scaling up point-of-care testing services.

塞拉利昂农村地区乙肝治疗纵向随访的障碍:关于继续接受治疗的混合方法研究。
在资源有限的环境中,HBV 的影响尤为严重,让患者继续接受纵向治疗仍是一项挑战。我们采用混合方法进行了一项调查,以了解塞拉利昂农村地区一家 HBV 诊所中失去随访机会的原因。我们建立了一个多变量逻辑回归模型,对预测随访损失的基线临床和社会人口学因素进行了分析,随访损失的定义是在入院后 14 个月内未能进行随访。我们纳入了 2019 年 4 月 30 日至 2020 年 3 月 1 日期间入组的患者,允许在 2021 年 4 月 30 日之前进行 14 个月的随访。然后,我们制定了一项调查,以征求患者对留住患者所面临挑战的看法。我们随机采访了至少 6 个月未接受 HBV 治疗的患者。在科诺 HBV 诊所登记的 271 名患者中,有 176 人(64.9%)在研究终点后的 14 个月内没有接受随访。基线检查不完整(aOR 2.9;95% CI:1.6-4.8)、基线时缺乏治疗(aOR 5.0;95% CI:1.7-14.4)和基线时患有肝硬化(aOR 3.3;95% CI:0.99-10.8)与随访缺失独立相关。在患者调查方面,21 名患者完成了访谈(中位年龄为 34 岁 [IQR:25-38])。与旅行相关的因素是最常被报告的影响患者继续就医的障碍(57%)。近 30% 的患者认为,改善客户服务可能有助于留住患者;24% 的患者要求获得药物治疗。在我们的环境中,可减少随访损失的因素包括:扩大治疗启动标准、克服交通障碍、减少等待时间、确保无库存以及扩大护理点检测服务。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical Liver Disease
Clinical Liver Disease Medicine-Hepatology
CiteScore
4.10
自引率
0.00%
发文量
96
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