Does type of antiretroviral therapy pick-up point influence 12-month virologic suppression in South Africa?

IF 1.2 4区 医学 Q4 HEALTH POLICY & SERVICES
Ingrid V Bassett, Joyce Yan, Sabina Govere, Anele Khumalo, Zinhle Shazi, Mpilonhle Nzuza, Taing Aung, Kashfia Rahman, Dani Zionts, Nduduzo Dube, Sandile Tshabalala, Laura M Bogart, Robert A Parker
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Abstract

We assessed the impact of community- versus clinic-based medication pick-up on rates of virologic suppression in an observational cohort of adults on ART enrolled in a decentralized antiretroviral therapy program (CCMDD) in South Africa. Participants either attended clinics where they were given the choice to pick up ART in community venues or traditional clinics, or clinics where this pathway was assigned. Among 1856 participants, 977 (53%) opted for community ART pick-up at enrollment, and 1201 (86%) were virologically suppressed at one year. Because of missing data on virologic suppression, primary results are based on a model incorporating multiple imputation. In addition to age and gender, distance from clinic and year of HIV diagnosis were included in the multivariable model. There was no difference in opting for clinic- vs. community-based pick-up with regard to achieving 12-month virologic suppression (aRR 1.02, 95% CI 0.98-1.05) in clinics offering choice. There was no impact of assigning all participants to an external pick-up point (aRR 1.00, 95% CI 0.95-1.06), but virologic suppression was reduced in the clinic that assigned participants to clinic pick-up (aRR 0.87, 95% CI 0.81-0.92). These results suggest that provision of community-based ART has not reduced continued virologic suppression in the population enrolled in the CCMDD program.

在南非,抗逆转录病毒疗法接种点的类型会影响 12 个月的病毒学抑制吗?
我们评估了社区取药与诊所取药对南非分散型抗逆转录病毒疗法项目(CCMDD)成人抗逆转录病毒疗法病毒学抑制率的影响。参与者可以选择在社区或传统诊所接受抗逆转录病毒疗法,也可以选择在指定的诊所接受抗逆转录病毒疗法。在 1856 名参与者中,977 人(53%)在注册时选择了社区抗逆转录病毒疗法,1201 人(86%)在一年后病毒学检测得到抑制。由于病毒学抑制数据缺失,主要结果基于一个包含多重估算的模型。除年龄和性别外,多变量模型还包括距离诊所的距离和确诊 HIV 的年份。在提供选择的诊所中,选择诊所取药与选择社区取药在实现 12 个月病毒学抑制方面没有差异(aRR 1.02,95% CI 0.98-1.05)。将所有参与者分配到外部取药点没有影响(aRR 1.00,95% CI 0.95-1.06),但将参与者分配到诊所取药的诊所的病毒抑制率降低了(aRR 0.87,95% CI 0.81-0.92)。这些结果表明,提供社区抗逆转录病毒疗法并没有减少 CCMDD 项目参与人群的持续病毒学抑制。
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来源期刊
CiteScore
3.50
自引率
0.00%
发文量
172
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