PDF(Pubmed)
Abstract：
UNASSIGNED: Cameroon adopted and started implementing in 2016, the \'universal test and treat\' (UTT) guidelines to fast-track progress towards the 95-95-95 ambitious targets to end the HIV epidemic. UTT has shown inconsistent results elsewhere and has not yet been assessed in Cameroon. We aimed to evaluate the effectiveness of this novel approach on the quality of care and health outcomes of people living with HIV (PLHIV).
UNASSIGNED: A retrospective cohort design was conducted at The Nkongsamba Regional Hospital, using routine clinical service delivery data to measure uptake levels of UTT and CD4 testing, and to compare the incidence of opportunistic infections (OI) between PLHIV initiated on ART based on the \"Universal Test and Treat\" strategy and those initiated on ART based on the standard deferred approach between 2002 and 2020. Kaplan Meier plots and log-rank tests were used to compare OI events between the pre-UTT and post-UTT eras. The Cox regression model was used to screen for factors independently associated with the risk of acquisition of OI.
UNASSIGNED: The uptake of UTT ranged from 39.1% to 92.8% while baseline CD4 count testing reduced drastically from 89.4% to 0.4% between 2016 to 2020 respectively. The median delay in ART initiation declined significantly from 21 days (IQR: 9 - 113) in the pre-UTT era to the same day of diagnosis (IQR: 0 - 2) in the UTT era (p < 0.001). The incidence of all OI events reported was over five times higher during the UTT era than in the pre-UTT era [aHR = 5.55 (95% CI: 3.18 - 9.69), p < 0.001].
UNASSIGNED: The UTT policy has been effectively rolled out and has contributed to improved access to rapid and immediate ART initiation, but a higher incidence of OIs was observed with a rollback of baseline CD4 testing. We advocate for a return to routine baseline CD4 measurement to identify PLHIV who should benefit from interventions to prevent OIs for optimal outcomes under the UTT approach.
UNASSIGNED: A retrospective cohort design was conducted at The Nkongsamba Regional Hospital, using routine clinical service delivery data to measure uptake levels of UTT and CD4 testing, and to compare the incidence of opportunistic infections (OI) between PLHIV initiated on ART based on the \"Universal Test and Treat\" strategy and those initiated on ART based on the standard deferred approach between 2002 and 2020. Kaplan Meier plots and log-rank tests were used to compare OI events between the pre-UTT and post-UTT eras. The Cox regression model was used to screen for factors independently associated with the risk of acquisition of OI.
UNASSIGNED: The uptake of UTT ranged from 39.1% to 92.8% while baseline CD4 count testing reduced drastically from 89.4% to 0.4% between 2016 to 2020 respectively. The median delay in ART initiation declined significantly from 21 days (IQR: 9 - 113) in the pre-UTT era to the same day of diagnosis (IQR: 0 - 2) in the UTT era (p < 0.001). The incidence of all OI events reported was over five times higher during the UTT era than in the pre-UTT era [aHR = 5.55 (95% CI: 3.18 - 9.69), p < 0.001].
UNASSIGNED: The UTT policy has been effectively rolled out and has contributed to improved access to rapid and immediate ART initiation, but a higher incidence of OIs was observed with a rollback of baseline CD4 testing. We advocate for a return to routine baseline CD4 measurement to identify PLHIV who should benefit from interventions to prevent OIs for optimal outcomes under the UTT approach.
摘要：
喀麦隆于2016年通过并开始实施“通用测试和治疗”（UTT）指南，以快速实现95-95-95的雄心勃勃的目标，以结束艾滋病毒的流行。UTT在其他地方显示出不一致的结果，并且尚未在喀麦隆进行评估。我们旨在评估这种新方法对艾滋病毒感染者（PLHIV）的护理质量和健康结果的有效性。
■在恩孔桑巴地区医院进行了回顾性队列设计，使用常规的临床服务数据来测量UTT和CD4检测的摄取水平，并比较2002年至2020年期间基于“通用测试和治疗”策略在ART上启动的PLHIV和基于标准延迟方法在ART上启动的PLHIV之间的机会性感染（OI）发生率。使用KaplanMeier图和对数秩检验来比较UTT前和UTT后时期之间的OI事件。Cox回归模型用于筛选与OI获得风险独立相关的因素。
■UTT的摄取范围为39.1％至92.8％，而基线CD4计数检测在2016年至2020年期间分别从89.4％急剧下降至0.4％。从UTT前时代的21天（IQR：9-113）到UTT时代的诊断同一天（IQR：0-2），ART启动的中位延迟显着下降（p<0.001）。在UTT时代报告的所有OI事件的发生率比UTT时代前的高五倍[aHR=5.55（95％CI：3.18-9.69），p<0.001]。
■UTT政策已有效推出，并有助于改善快速和即时ART启动的访问，但随着基线CD4检测的回滚,OIs的发生率更高.我们主张恢复常规基线CD4测量，以确定PLHIV谁应该从干预措施中受益，以预防OIs，从而在UTT方法下获得最佳结果。
■在恩孔桑巴地区医院进行了回顾性队列设计，使用常规的临床服务数据来测量UTT和CD4检测的摄取水平，并比较2002年至2020年期间基于“通用测试和治疗”策略在ART上启动的PLHIV和基于标准延迟方法在ART上启动的PLHIV之间的机会性感染（OI）发生率。使用KaplanMeier图和对数秩检验来比较UTT前和UTT后时期之间的OI事件。Cox回归模型用于筛选与OI获得风险独立相关的因素。
■UTT的摄取范围为39.1％至92.8％，而基线CD4计数检测在2016年至2020年期间分别从89.4％急剧下降至0.4％。从UTT前时代的21天（IQR：9-113）到UTT时代的诊断同一天（IQR：0-2），ART启动的中位延迟显着下降（p<0.001）。在UTT时代报告的所有OI事件的发生率比UTT时代前的高五倍[aHR=5.55（95％CI：3.18-9.69），p<0.001]。
■UTT政策已有效推出，并有助于改善快速和即时ART启动的访问，但随着基线CD4检测的回滚,OIs的发生率更高.我们主张恢复常规基线CD4测量，以确定PLHIV谁应该从干预措施中受益，以预防OIs，从而在UTT方法下获得最佳结果。
