当前位置： SCI文献检索 > AIDS Research and Therapy期刊下所有文献 > Community-based ART distribution system can effectively facilitate long-term program retention and low-rates of death and virologic failure in rural Uganda.

Community-based ART distribution system can effectively facilitate long-term program retention and low-rates of death and virologic failure in rural Uganda.

Abstract：

BACKGROUND:Community-drug distribution point is a care model for stable patients in the community designed to make ART delivery more efficient for the health system and provide appropriate support to encourage long-term retention of patients. We examined program retention among ART program participants in rural Uganda, which has used a community-based distribution model of ART delivery since 2004. METHODS:We analyzed data of all patients >18 years who initiated ART in Jinja, Ugandan site of The AIDS Support Organization between January 1, 2004 and July 31, 2009. Participants attended clinic or outreach visits every 2-3 months and had CD4 cell counts measured every 6 months. Retention to care was defined as any patient with at least one visit in the 6 months before June 1, 2013. We then identified participants with at least one visit in the 6 months before June 1, 2013 and examined associations with mortality and lost-to-follow-up (LTFU). Participants with >4 years of follow up during August, 2012 to May, 2013 had viral load conducted, since no routine viral load testing was available. RESULTS:A total of 3345 participants began ART during 2004-2009. The median time on ART in June 2013 was 5.69 years. A total of 1335 (40 %) were residents of Jinja district and 2005 (60 %) resided in outlying districts. Of these, 2322 (69 %) were retained in care, 577 (17 %) died, 161 (5 %) transferred out and 285 (9 %) were LTFU. Factors associated with mortality or LTFU included male gender, [Adjusted Hazard Ratio (AHR) = 1.56; 95 % CI 1.28-1.9], CD4 cell count <50 cells/μL (AHR = 4.09; 95 % CI 3.13-5.36) or 50-199 cells/μL (AHR = 1.86; 95 % CI 1.46-2.37); ART initiation and WHO stages 3 (AHR = 1.35; 95 % CI 1.1-1.66) or 4 (AHR = 1.74; 95 % CI 1.23-2.45). Residence outside of Jinja district was not associated with mortality/LTFU (p value = 0.562). Of 870 participants who had VL tests, 756 (87 %) had VLs <50 copies/mL. CONCLUSION:Community-based ART distribution systems can effectively mitigate the barriers to program retention and result in good rates of virologic suppression.

journal_name

AIDS Res Ther

journal_title

AIDS research and therapy

authors

Okoboi S,Ding E,Persuad S,Wangisi J,Birungi J,Shurgold S,Kato D,Nyonyintono M,Egessa A,Bakanda C,Munderi P,Kaleebu P,Moore DM

doi

10.1186/s12981-015-0077-4

subject

Has Abstract

pub_date

2015-11-12 00:00:00

pages

issn

1742-6405

pii

journal_volume

pub_type

杂志文章

在线工具

Community-based ART distribution system can effectively facilitate long-term program retention and low-rates of death and virologic failure in rural Uganda.