PDF(Pubmed)
Abstract：
The continuum of care (CoC) model has been used to describe the main pillars of HIV care. This study aims to systematically review methods and elucidate gaps in the CoC analyses, especially in terms of the timing of the progression through steps, recognized nowadays as a critical parameter for an effective response to the epidemic.
A PubMed and EMBASE databases search up to December 2019 resulted in 1918 articles, of which 209 were included in this review; 84 studies presented in major HIV conferences were also included. Studies that did not provide explicit definitions, modelling studies and those reporting only on metrics for subpopulations or factors affecting a CoC stage were excluded. Included articles reported results on 1 to 6 CoC stages.
Percentage treated and virally suppressed was reported in 78%, percentage diagnosed and retained in care in 58%, percentage linked to care in 54% and PLHIV in 36% of the articles. Information for all stages was provided in 23 studies. Only 6 articles use novel CoC estimates: One presents a dynamic CoC based on multistate analysis techniques, two base their time-to-next-stage estimates on a risk estimation method based on the cumulative incidence function, weighted for confounding and censoring and three studies estimated the HIV infection time based on mathematical modelling.
A limited number of studies provide elaborated time analyses of the CoC. Although time analyses lack the straightforward interpretation of the cross-sectional CoC, they provide valuable insights for the timely response to the HIV epidemic. A future goal would be to develop a model that retains the simplicity of the cross-sectional CoC but also incorporates timing between stages.
A PubMed and EMBASE databases search up to December 2019 resulted in 1918 articles, of which 209 were included in this review; 84 studies presented in major HIV conferences were also included. Studies that did not provide explicit definitions, modelling studies and those reporting only on metrics for subpopulations or factors affecting a CoC stage were excluded. Included articles reported results on 1 to 6 CoC stages.
Percentage treated and virally suppressed was reported in 78%, percentage diagnosed and retained in care in 58%, percentage linked to care in 54% and PLHIV in 36% of the articles. Information for all stages was provided in 23 studies. Only 6 articles use novel CoC estimates: One presents a dynamic CoC based on multistate analysis techniques, two base their time-to-next-stage estimates on a risk estimation method based on the cumulative incidence function, weighted for confounding and censoring and three studies estimated the HIV infection time based on mathematical modelling.
A limited number of studies provide elaborated time analyses of the CoC. Although time analyses lack the straightforward interpretation of the cross-sectional CoC, they provide valuable insights for the timely response to the HIV epidemic. A future goal would be to develop a model that retains the simplicity of the cross-sectional CoC but also incorporates timing between stages.
摘要：
连续护理（CoC）模型已用于描述HIV护理的主要支柱。这项研究旨在系统地回顾方法，阐明CoC分析中的差距，特别是在步骤进展的时间方面，如今被认为是有效应对这一流行病的关键参数。
截至2019年12月的PubMed和EMBASE数据库搜索产生了1918篇文章，其中209项被纳入本综述;84项在主要HIV会议上发表的研究也被纳入.没有提供明确定义的研究，模型研究和仅报告亚群或影响CoC分期的因素的指标的研究被排除.纳入的文章报告了1至6个CoC阶段的结果。
据报道，治疗和病毒抑制的百分比为78%，诊断和保留在护理中的百分比为58%，与护理相关的百分比为54%，与PLHIV相关的百分比为36%。23项研究提供了所有阶段的信息。只有6篇文章使用了新的CoC估计：一篇文章提出了基于多状态分析技术的动态CoC，两个基于累积发生率函数的风险估计方法，加权混淆和审查，三项研究基于数学建模估计了艾滋病毒感染时间。
有限数量的研究提供了CoC的详细时间分析。尽管时间分析缺乏对横截面CoC的直接解释，它们为及时应对艾滋病毒流行提供了宝贵的见解。未来的目标是开发一种模型，该模型保留了横截面CoC的简单性，但也包含了阶段之间的时序。
截至2019年12月的PubMed和EMBASE数据库搜索产生了1918篇文章，其中209项被纳入本综述;84项在主要HIV会议上发表的研究也被纳入.没有提供明确定义的研究，模型研究和仅报告亚群或影响CoC分期的因素的指标的研究被排除.纳入的文章报告了1至6个CoC阶段的结果。
据报道，治疗和病毒抑制的百分比为78%，诊断和保留在护理中的百分比为58%，与护理相关的百分比为54%，与PLHIV相关的百分比为36%。23项研究提供了所有阶段的信息。只有6篇文章使用了新的CoC估计：一篇文章提出了基于多状态分析技术的动态CoC，两个基于累积发生率函数的风险估计方法，加权混淆和审查，三项研究基于数学建模估计了艾滋病毒感染时间。
有限数量的研究提供了CoC的详细时间分析。尽管时间分析缺乏对横截面CoC的直接解释，它们为及时应对艾滋病毒流行提供了宝贵的见解。未来的目标是开发一种模型，该模型保留了横截面CoC的简单性，但也包含了阶段之间的时序。
