在乌干达,关键和优先人群(有风险行为和健康不平等)受到艾滋病毒的不成比例的影响。我们评估了强化病例管理干预对Kalangala区HIV治疗结果的影响。主要居住在渔民和女性性工作者中。
这项准实验性干预前评估包括干预前(2017年1月1日至2017年12月31日)和干预阶段(2018年6月13日至2019年6月30日)来自6个医疗机构的18岁以上的初治成人抗逆转录病毒治疗。主要结果是在实施干预之前和之后的6个月保留和病毒抑制(VS),该干预涉及至少在ART的前三个月为参与者提供支持的机构和社区病例管理人员。我们使用描述性统计来比较特征,总体结果(即,保留,失去了跟进,死亡),和各阶段参与者的VS,并使用混合效应逻辑回归模型来确定与6个月护理保留相关的因素。根据最终的多变量模型计算保留的边际(设施上的平均)概率。
我们分别在干预前和干预阶段招募了606名和405名参与者。大约75%的参与者年龄在25-44岁之间。各阶段年龄和性别分布相似。大约46%的参与者是渔民,9%是女性性工作者。在干预阶段,6个月保留的调整概率更高,0.83(95%CI:0.77-0.90)与干预前阶段相比,0.73(95%CI:0.69-0.77,p=0.03)。保留概率从0.59(0.49-0.68)增加到0.73(0.59-0.86),在18-24岁的参与者中,p=0.03,从0.75(0.71-0.78)到0.85(0.78-0.91),年龄≥25岁的参与者中p=0.03。在两个阶段中,VS(<1,000拷贝/mL)约为87%。
实施病例管理干预后,我们观察到,在以渔民为主的高度流动人口中,所有年龄组的6个月保留率均有显着改善。
Key and priority populations (with risk behaviours and health inequities) are disproportionately affected by HIV in Uganda. We evaluated the impact of an intensive
case management intervention on HIV treatment outcomes in Kalangala District, predominantly inhabited by fisher folk and female sex workers.
This quasi-experimental pre-post intervention evaluation included antiretroviral therapy naïve adults aged ≥ 18 years from six health facilities in the pre-intervention (Jan 1, 2017-December 31, 2017) and intervention phase (June 13, 2018-June 30, 2019). The primary outcomes were 6-month retention and viral suppression (VS) before and after implementation of the intervention involving facility and community
case managers who supported participants through at least the first three months of ART. We used descriptive statistics to compared the characteristics, overall outcomes (i.e., retention, lost to follow up, died), and VS of participants by phase, and used mixed-effects logistic regression models to determine factors associated with 6-month retention in care. Marginal (averaging over facilities) probabilities of retention were computed from the final multivariable model.
We enrolled 606 and 405 participants in the pre-intervention and intervention phases respectively. Approximately 75% of participants were aged 25-44 years, with similar age and gender distributions among phases. Approximately 46% of participants in the intervention were fisher folk and 9% were female sex workers. The adjusted probability of 6-month retention was higher in the intervention phase, 0.83 (95% CI: 0.77-0.90) versus pre-intervention phase, 0.73 (95% CI: 0.69-0.77, p = 0.03). The retention probability increased from 0.59 (0.49-0.68) to 0.73 (0.59-0.86), p = 0.03 among participants aged 18-24 years, and from 0.75 (0.71-0.78) to 0.85 (0.78-0.91), p = 0.03 among participants aged ≥ 25 years. VS (< 1,000 copies/mL) was approximately 87% in both phases.
After implementation of the
case management intervention, we observed significant improvement in 6-month retention in all age groups of a highly mobile population of predominantly fisher folk.