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Abstract：
UNASSIGNED: sustaining high rates of retention is critical for management of HIV clients, newly initiated antiretroviral therapy (ART). In low resource settings including Tanzania, retention among clients on ART was challenging due to inaccessible infrastructure, gender-based violence, inadequate skilled staff and socio-economic disparities. Low retention leads to increased morbidity and mortality. Tanzania adopted universal test and treat (UTT) strategy in mid of 2016 as recommended by Joint United Nations Program on HIV/AIDS (UNAID) that set goals for HIV epidemic control globally. Studies demonstrated controversial findings on whether UTT strategy improves retention, until now there is limited information on the effect of UTT on retaining HIV patients in our settings.
UNASSIGNED: a retrospective cohort study was conducted between July 2014 to June 2015 and July 2017 to June 2018 to determine 12 months ART retention among clients newly initiated ART prior and during universal test and treat (UTT) strategy in Geita Region, Tanzania. A total of 13,649 newly clients-initiated ART were extracted from the National AIDS control care and treatment database (CTC2 database). Among these clients 4,624 initiated ART prior the UTT strategy and clients 9,025 start ART after the rollout of UTT strategy. Chi-square test was deployed to determine the significant difference of proportion within categories for each UTT group. Kaplan-Meier curve and long rank test were used to determine significant differences of retention rate prior and during UTT program. Cox regression models were used to estimate the association between exposure variables and ART retention with 95% confidence intervals and p-value of p<0.05.
UNASSIGNED: the overall mean age at ART initiation was 38 years (SD=11.6) with observed significant mean difference between two cohorts (prior UTT, mean=41, SD=11.7 Vs during UTT, mean=37, SD=11.3). The cumulative retention was 83.1% among newly initiated ART clients in both cohorts with significant difference observed between two cohorts (69.7% for prior UTT and 89.9% during UTT, p-value<0.001). The overall person year of follow up was 127,209.3 with an incidence rate of ART retention of 86 per 1000 person-year. It was significantly higher among clients enrolled during UTT strategy than clients enrolled prior UTT strategy (95.1 per 1000 PY Vs 69.6 per 1000 PY, p-value<0.001). The log rank test and Kaplan-Meier survival curve demonstrated clients enrolled in the UTT program had greater probability of retention than clients enrolled prior UTT treatment program (log rank X2 test = 599.2, p value < 0.001). Newly HIV clients who initiated ART after the rollout of UTT strategy had 27% higher likelihood to be retained in care and treatment as compared to clients who were enrolled prior UTT strategy, (HR=1.27; 95% CI [1.21 -1.33], p value < 0.001). Sex, District councils, World health Organisation (WHO) stage and client\'s visit type were significant factors associated with retention among clients newly initiated to care for both arms.
UNASSIGNED: this results, showed that probability of ART retention increased after the rollout of UTT strategy. There is a need to promote universal test and treat strategy in line with other intervention to control HIV epidemic in Geita, Tanzania.
UNASSIGNED: a retrospective cohort study was conducted between July 2014 to June 2015 and July 2017 to June 2018 to determine 12 months ART retention among clients newly initiated ART prior and during universal test and treat (UTT) strategy in Geita Region, Tanzania. A total of 13,649 newly clients-initiated ART were extracted from the National AIDS control care and treatment database (CTC2 database). Among these clients 4,624 initiated ART prior the UTT strategy and clients 9,025 start ART after the rollout of UTT strategy. Chi-square test was deployed to determine the significant difference of proportion within categories for each UTT group. Kaplan-Meier curve and long rank test were used to determine significant differences of retention rate prior and during UTT program. Cox regression models were used to estimate the association between exposure variables and ART retention with 95% confidence intervals and p-value of p<0.05.
UNASSIGNED: the overall mean age at ART initiation was 38 years (SD=11.6) with observed significant mean difference between two cohorts (prior UTT, mean=41, SD=11.7 Vs during UTT, mean=37, SD=11.3). The cumulative retention was 83.1% among newly initiated ART clients in both cohorts with significant difference observed between two cohorts (69.7% for prior UTT and 89.9% during UTT, p-value<0.001). The overall person year of follow up was 127,209.3 with an incidence rate of ART retention of 86 per 1000 person-year. It was significantly higher among clients enrolled during UTT strategy than clients enrolled prior UTT strategy (95.1 per 1000 PY Vs 69.6 per 1000 PY, p-value<0.001). The log rank test and Kaplan-Meier survival curve demonstrated clients enrolled in the UTT program had greater probability of retention than clients enrolled prior UTT treatment program (log rank X2 test = 599.2, p value < 0.001). Newly HIV clients who initiated ART after the rollout of UTT strategy had 27% higher likelihood to be retained in care and treatment as compared to clients who were enrolled prior UTT strategy, (HR=1.27; 95% CI [1.21 -1.33], p value < 0.001). Sex, District councils, World health Organisation (WHO) stage and client\'s visit type were significant factors associated with retention among clients newly initiated to care for both arms.
UNASSIGNED: this results, showed that probability of ART retention increased after the rollout of UTT strategy. There is a need to promote universal test and treat strategy in line with other intervention to control HIV epidemic in Geita, Tanzania.
摘要：
■保持高保留率对于管理艾滋病毒患者至关重要，新开始的抗逆转录病毒治疗（ART）。在包括坦桑尼亚在内的低资源环境中，由于基础设施无法访问，客户在ART上的保留是具有挑战性的，基于性别的暴力，熟练的工作人员不足和社会经济差距。低保留率导致发病率和死亡率增加。坦桑尼亚于2016年年中采用了联合国艾滋病毒/艾滋病联合规划署（UNAID）建议的通用测试和治疗（UTT）战略，该战略为全球艾滋病毒流行控制设定了目标。研究表明，关于UTT策略是否可以提高保留率，到目前为止,关于UTT对在我们的环境中保留HIV患者的影响的信息有限.
■在2014年7月至2015年6月以及2017年7月至2018年6月之间进行了一项回顾性队列研究，以确定在Geita地区的通用测试和治疗（UTT）策略之前和期间新启动ART的客户的12个月ART保留率。坦桑尼亚。从国家艾滋病控制护理和治疗数据库（CTC2数据库）中提取了总共13,649名新客户发起的ART。在这些客户中，有4,624在UTT策略之前启动了ART，而9,025在UTT策略推出之后启动了ART。采用卡方检验来确定每个UTT组的类别内比例的显着差异。使用Kaplan-Meier曲线和长秩检验来确定UTT程序之前和期间的保留率的显着差异。Cox回归模型用于估计暴露变量与ART保留之间的关联，95%置信区间和p值p<0.05。
■开始ART时的总体平均年龄为38岁（SD=11.6），观察到两个队列之间的显着平均差异（先前的UTT，在UTT期间，平均值=41，SD=11.7Vs，平均值=37，标准差=11.3)。在两个队列中新启动的ART客户中，累积保留率为83.1％，在两个队列之间观察到显着差异（先前UTT为69.7％，在UTT期间为89.9％，p值<0.001)。总体随访人年为127,209.3，ART保留发生率为86/1000人年。在UTT策略期间注册的客户明显高于在UTT策略之前注册的客户（每1000日元95.1比每1000日元69.6，p值<0.001)。对数秩检验和Kaplan-Meier存活曲线表明，加入UTT计划的客户比之前加入UTT治疗计划的客户具有更大的保留概率（对数秩X2检验=599.2，p值<0.001）。与之前加入UTT策略的客户相比，在UTT策略推出后启动ART的新HIV客户保留在护理和治疗中的可能性要高27％。（HR=1.27；95%CI[1.21-1.33]，p值<0.001)。性,区议会,世界卫生组织（WHO）的阶段和客户的访问类型是与新开始照顾两个武器的客户之间的保留相关的重要因素。
■这个结果，表明，在UTT策略推出后，ART保留的可能性增加。有必要促进与其他干预措施相一致的普遍检测和治疗策略，以控制Geita的艾滋病毒流行，坦桑尼亚。
■在2014年7月至2015年6月以及2017年7月至2018年6月之间进行了一项回顾性队列研究，以确定在Geita地区的通用测试和治疗（UTT）策略之前和期间新启动ART的客户的12个月ART保留率。坦桑尼亚。从国家艾滋病控制护理和治疗数据库（CTC2数据库）中提取了总共13,649名新客户发起的ART。在这些客户中，有4,624在UTT策略之前启动了ART，而9,025在UTT策略推出之后启动了ART。采用卡方检验来确定每个UTT组的类别内比例的显着差异。使用Kaplan-Meier曲线和长秩检验来确定UTT程序之前和期间的保留率的显着差异。Cox回归模型用于估计暴露变量与ART保留之间的关联，95%置信区间和p值p<0.05。
■开始ART时的总体平均年龄为38岁（SD=11.6），观察到两个队列之间的显着平均差异（先前的UTT，在UTT期间，平均值=41，SD=11.7Vs，平均值=37，标准差=11.3)。在两个队列中新启动的ART客户中，累积保留率为83.1％，在两个队列之间观察到显着差异（先前UTT为69.7％，在UTT期间为89.9％，p值<0.001)。总体随访人年为127,209.3，ART保留发生率为86/1000人年。在UTT策略期间注册的客户明显高于在UTT策略之前注册的客户（每1000日元95.1比每1000日元69.6，p值<0.001)。对数秩检验和Kaplan-Meier存活曲线表明，加入UTT计划的客户比之前加入UTT治疗计划的客户具有更大的保留概率（对数秩X2检验=599.2，p值<0.001）。与之前加入UTT策略的客户相比，在UTT策略推出后启动ART的新HIV客户保留在护理和治疗中的可能性要高27％。（HR=1.27；95%CI[1.21-1.33]，p值<0.001)。性,区议会,世界卫生组织（WHO）的阶段和客户的访问类型是与新开始照顾两个武器的客户之间的保留相关的重要因素。
■这个结果，表明，在UTT策略推出后，ART保留的可能性增加。有必要促进与其他干预措施相一致的普遍检测和治疗策略，以控制Geita的艾滋病毒流行，坦桑尼亚。
