PDF(Pubmed)
Abstract：
This study aimed to help the Namibian government understand the impact of Treat All implementation (started on April 1, 2017) on key antiretroviral therapy (ART) outcomes, and how this transition impacts progress toward the UNAIDS\'s 90-90-90 HIV targets.
We collected clinical records from two separate cohorts (before and after treat-all) of ART patients in 10 high- and medium-volume facilities in 6 northern Namibia districts. Each cohort contains 12-month data on patients\' scheduled appointments and visits, health status, and viral load results. We also measured patients\' wait time and perceptions of service quality using exit interviews with 300 randomly selected patients (per round). We compared ART outcomes of the two cohorts: ART initiation within 7 days from diagnosis, loss to follow-up (LTFU), missed scheduled appointments for at least 30 days, and viral suppression using unadjusted and adjusted analyses.
Among new ART clients (on ART for less than 3 months or had not yet initiated treatment as of the start date for the ART record review period), rapid ART initiation (within 7 days from diagnosis) was 5.2 times higher after Treat All than that among clients assessed before the policy took effect [AOR: 5.2 (3.8-6.9)]. However, LTFU was higher after Treat All roll-out compared to before Treat All [AOR: 1.9 (1.3-2.8)]. Established ART clients (on ART treatment for at least three months at the start date of the ART record review period) had over 3 times greater odds of achieving viral suppression after Treat All roll-out compared to established ART clients assessed before Treat All [AOR: 3.1 (1.6-5.9)].
The findings indicate positive effect of the \"Treat All\" implementation on ART initiation and viral suppression, and negative effect on LTFU. Additionally, by April 2018, Namibia seems to have reached the UNAIDS\'s 90-90-90 targets.
We collected clinical records from two separate cohorts (before and after treat-all) of ART patients in 10 high- and medium-volume facilities in 6 northern Namibia districts. Each cohort contains 12-month data on patients\' scheduled appointments and visits, health status, and viral load results. We also measured patients\' wait time and perceptions of service quality using exit interviews with 300 randomly selected patients (per round). We compared ART outcomes of the two cohorts: ART initiation within 7 days from diagnosis, loss to follow-up (LTFU), missed scheduled appointments for at least 30 days, and viral suppression using unadjusted and adjusted analyses.
Among new ART clients (on ART for less than 3 months or had not yet initiated treatment as of the start date for the ART record review period), rapid ART initiation (within 7 days from diagnosis) was 5.2 times higher after Treat All than that among clients assessed before the policy took effect [AOR: 5.2 (3.8-6.9)]. However, LTFU was higher after Treat All roll-out compared to before Treat All [AOR: 1.9 (1.3-2.8)]. Established ART clients (on ART treatment for at least three months at the start date of the ART record review period) had over 3 times greater odds of achieving viral suppression after Treat All roll-out compared to established ART clients assessed before Treat All [AOR: 3.1 (1.6-5.9)].
The findings indicate positive effect of the \"Treat All\" implementation on ART initiation and viral suppression, and negative effect on LTFU. Additionally, by April 2018, Namibia seems to have reached the UNAIDS\'s 90-90-90 targets.
摘要：
这项研究旨在帮助纳米比亚政府了解TreatAll实施（于2017年4月1日开始）对关键抗逆转录病毒治疗（ART）结果的影响。以及这种转变如何影响联合国艾滋病规划署90-90-90艾滋病毒目标的进展。
我们在纳米比亚北部6个地区的10个高容量和中等容量设施中收集了两个独立的ART患者队列（治疗前后）的临床记录。每个队列包含12个月的患者预约和访问数据，健康状况,和病毒载量结果。我们还使用随机选择的300名患者（每轮）的退出访谈来测量患者的等待时间和对服务质量的看法。我们比较了两个队列的ART结果：诊断后7天内开始ART，后续损失(LTFU)，错过了至少30天的预定约会，和病毒抑制使用未调整和调整的分析。
在新的ART患者中（接受ART治疗少于3个月或在ART记录审查期开始日期尚未开始治疗），治疗后的快速ART开始(自诊断起7天内)比政策生效前评估的患者高5.2倍[AOR:5.2(3.8-6.9)].然而,与全部治疗前相比，全部治疗后的LTFU较高[AOR：1.9（1.3-2.8）]。已建立的ART客户（在ART记录审查期的开始日期接受至少三个月的ART治疗）在“治疗全部”推出后实现病毒抑制的几率是“治疗全部”前评估的已建立ART客户的3倍以上[AOR：3.1（1.6-5.9）]。
研究结果表明，“全面治疗”实施对ART启动和病毒抑制的积极影响，以及对LTFU的负面影响。此外,到2018年4月，纳米比亚似乎已经达到了联合国艾滋病规划署的90-90-90目标。
我们在纳米比亚北部6个地区的10个高容量和中等容量设施中收集了两个独立的ART患者队列（治疗前后）的临床记录。每个队列包含12个月的患者预约和访问数据，健康状况,和病毒载量结果。我们还使用随机选择的300名患者（每轮）的退出访谈来测量患者的等待时间和对服务质量的看法。我们比较了两个队列的ART结果：诊断后7天内开始ART，后续损失(LTFU)，错过了至少30天的预定约会，和病毒抑制使用未调整和调整的分析。
在新的ART患者中（接受ART治疗少于3个月或在ART记录审查期开始日期尚未开始治疗），治疗后的快速ART开始(自诊断起7天内)比政策生效前评估的患者高5.2倍[AOR:5.2(3.8-6.9)].然而,与全部治疗前相比，全部治疗后的LTFU较高[AOR：1.9（1.3-2.8）]。已建立的ART客户（在ART记录审查期的开始日期接受至少三个月的ART治疗）在“治疗全部”推出后实现病毒抑制的几率是“治疗全部”前评估的已建立ART客户的3倍以上[AOR：3.1（1.6-5.9）]。
研究结果表明，“全面治疗”实施对ART启动和病毒抑制的积极影响，以及对LTFU的负面影响。此外,到2018年4月，纳米比亚似乎已经达到了联合国艾滋病规划署的90-90-90目标。
