PDF(Pubmed)
Abstract：
UNASSIGNED: an increasing number of persons living with HIV (PLHIV) are accessing antiretroviral therapy (ART) since the adoption of the universal test and treat (UTT) policy by Cameroon in 2016. We sought to evaluate the effectiveness of the UTT approach to keep this growing number of PLHIV on a lifelong treatment.
UNASSIGNED: a retrospective cohort analysis was conducted at the Nkongsamba Regional Hospital between 2002 and 2020, using routine data to compare the cumulative incidence of loss to follow-up (LTFU) and mortality between PLHIV initiated on ART under UTT guidelines and those initiated under the standard deferred approach. Chi-squared test was used to compare the risk of attrition between the guideline periods while multiple logistic regression modelling was used to adjust for confounders.
UNASSIGNED: of 1627 PLHIV included for analysis, 756 (46.47%) were enrolled during the era of UTT with 545 (33.54%) initiated on ART on the same day of HIV diagnosis. The transition to the UTT era was associated with an overall reduction in the risk of LTFU by 73% (aOR = 0.27, 95%CI: 0.17 - 0.45). There was modest evidence that the odds of mortality had increased under the UTT policy by about 3-fold (aOR = 2.86, 95%CI: 0.91-8.94). Same-day initiation had no overall effect on LTFU or mortality. LTFU was lower among the same-day initiators in the first 24 months but increased thereafter above the rate among late initiators.
UNASSIGNED: overall ART programme implementation under the UTT has led to a significant decline in LTFU though mortality appeared to have increased. Ongoing efforts to keep patients on long-term treatment should be sustained while other innovative schemes are sought.
UNASSIGNED: a retrospective cohort analysis was conducted at the Nkongsamba Regional Hospital between 2002 and 2020, using routine data to compare the cumulative incidence of loss to follow-up (LTFU) and mortality between PLHIV initiated on ART under UTT guidelines and those initiated under the standard deferred approach. Chi-squared test was used to compare the risk of attrition between the guideline periods while multiple logistic regression modelling was used to adjust for confounders.
UNASSIGNED: of 1627 PLHIV included for analysis, 756 (46.47%) were enrolled during the era of UTT with 545 (33.54%) initiated on ART on the same day of HIV diagnosis. The transition to the UTT era was associated with an overall reduction in the risk of LTFU by 73% (aOR = 0.27, 95%CI: 0.17 - 0.45). There was modest evidence that the odds of mortality had increased under the UTT policy by about 3-fold (aOR = 2.86, 95%CI: 0.91-8.94). Same-day initiation had no overall effect on LTFU or mortality. LTFU was lower among the same-day initiators in the first 24 months but increased thereafter above the rate among late initiators.
UNASSIGNED: overall ART programme implementation under the UTT has led to a significant decline in LTFU though mortality appeared to have increased. Ongoing efforts to keep patients on long-term treatment should be sustained while other innovative schemes are sought.
摘要：
■自2016年喀麦隆通过普遍检测和治疗（UTT）政策以来，越来越多的艾滋病毒感染者（PLHIV）正在接受抗逆转录病毒治疗（ART）。我们试图评估UTT方法的有效性，以保持这种不断增长的PLHIV终生治疗。
■于2002年至2020年在Nkongsamba地区医院进行了一项回顾性队列分析，使用常规数据比较了在UTT指南下接受ART治疗的PLHIV和在标准延期治疗下接受治疗的PLHIV之间的累积随访失败发生率（LTFU）和死亡率。卡方检验用于比较指南期之间的流失风险，而多元逻辑回归模型用于调整混杂因素。
■包括用于分析的1627例PLHIV，在UTT时代招募了756人（46.47%），其中545人（33.54%）在HIV诊断的同一天开始接受ART。向UTT时代的过渡与LTFU风险总体降低73%相关(aOR=0.27,95CI:0.17-0.45)。有适度的证据表明，在UTT政策下，死亡率增加了约3倍（aOR=2.86，95CI：0.91-8.94）。当天开始对LTFU或死亡率没有总体影响。在前24个月中，当天的发起人的LTFU较低，但此后的LTFU高于晚期发起人的比率。
■在UTT下实施的整体ART计划导致LTFU显着下降，尽管死亡率似乎有所增加。在寻求其他创新方案的同时，应继续努力使患者长期接受治疗。
■于2002年至2020年在Nkongsamba地区医院进行了一项回顾性队列分析，使用常规数据比较了在UTT指南下接受ART治疗的PLHIV和在标准延期治疗下接受治疗的PLHIV之间的累积随访失败发生率（LTFU）和死亡率。卡方检验用于比较指南期之间的流失风险，而多元逻辑回归模型用于调整混杂因素。
■包括用于分析的1627例PLHIV，在UTT时代招募了756人（46.47%），其中545人（33.54%）在HIV诊断的同一天开始接受ART。向UTT时代的过渡与LTFU风险总体降低73%相关(aOR=0.27,95CI:0.17-0.45)。有适度的证据表明，在UTT政策下，死亡率增加了约3倍（aOR=2.86，95CI：0.91-8.94）。当天开始对LTFU或死亡率没有总体影响。在前24个月中，当天的发起人的LTFU较低，但此后的LTFU高于晚期发起人的比率。
■在UTT下实施的整体ART计划导致LTFU显着下降，尽管死亡率似乎有所增加。在寻求其他创新方案的同时，应继续努力使患者长期接受治疗。
