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首页> 外文学位 >The HACART study Predictors and prediction modeling of loss to follow-up, immuno-virologic outcomes and sub-optimal drug adherence among adults on antiretroviral therapy in Nigeria.
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The HACART study Predictors and prediction modeling of loss to follow-up, immuno-virologic outcomes and sub-optimal drug adherence among adults on antiretroviral therapy in Nigeria.

机译：HACART研究了尼日利亚抗逆转录病毒疗法的成年人追踪失访，免疫病毒学结果和次优药物依从性的预测因素和预测模型。

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摘要

Context. HIV treatment access is now a reality in Nigeria. Concerns have now shifted from issues of treatment access to that of treatment retention, quality of care and treatment outcomes. Information on predictors and prediction models of loss to follow-up and treatment outcomes are not well described in Nigeria.;Objective. The HACART (HIV AIDS Care and Antiretroviral Therapy) study is an observational cohort study that aims to describe predictors of loss to follow-up and treatment outcomes and develop a prediction model for loss to follow-up in a HIV treatment program in Nigeria.;Design, setting and population. A cohort of 2585 ART naive adult patients who started HAART from April 2008 to February 2009 were followed for 12 months in three government hospitals: University of Abuja Teaching Hospital, Asokoro District Hospital and University of Benin Teaching Hospital. The study consisted of a prospective, a retrospective and a cross-sectional interview component.;Main outcomes. Loss to follow-up at 12 months, prediction modeling of loss to follow-up, immuno-virologic outcomes and sub-optimal drug adherence;Results. Of the 2585 patients followed up, 1706 (66%) were females. Median baseline CD4 cell count was 152 (IQR; 82--257), median baseline hemoglobin count was 10.5g/dl (IQR; 8.8--12) and 1169 (45.2%) patients were on Tenofovir-based ART regimen. Loss to follow-up was 31% (n=805).;In multivariate Cox proportional hazards regression model, an increased risk of LTFU was significantly associated with tuberculosis history and d4T-based ARV regimen. A decreased risk of LTFU was associated with HIV disclosure, baseline hemoglobin more than 10g/dl and CD4 > 50 cell / mm3. In the prediction model development, the model with the highest discrimination c-statistic of 0.63 and best calibration of 0.45 was shown.;Conclusion. Challenges in patient retention remain critical in HIV programs in Nigeria. Early treatment initiation with effective treatment preparation, better patient tracking systems, prophylactic treatment of malaria and helminthiasis (to address anemia), promotion of HIV disclosure, provider-initiated active TB case detection and discontinuation of d4T-based regimen will help decrease LTFU and improve immuno-virologic outcomes.
机译：上下文。在尼日利亚，获得艾滋病毒治疗已成为现实。现在，人们的担忧已从治疗准入问题转移到治疗保留，护理质量和治疗结果方面。尼日利亚未充分描述有关随访和治疗结果损失的预测因素和预测模型的信息。 HACART（HIV AIDS护理和抗逆转录病毒疗法）研究是一项观察性队列研究，旨在描述在尼日利亚的HIV治疗计划中，随访和治疗结果的损失预测因素，并建立随访损失的预测模型。设计，设置和人口。从2008年4月至2009年2月开始进行HAART的2585名未接受过ART治疗的成年患者，在阿布贾大学教学医院，阿索科罗区医院和贝宁大学教学医院这三所政府医院中随访了12个月。该研究由前瞻性，回顾性和横断面访谈组成。主要结果。在12个月后失去随访，对随访损失，免疫病毒学结果和次优药物依从性进行预测建模;结果。在2585名患者中，女性为1706名（66％）。接受基于替诺福韦的ART方案的基线CD4细胞计数中位数为152（IQR; 82--257），基线血红蛋白计数中位数为10.5g / dl（IQR; 8.8--12）和1169（45.2％）患者。随访损失率为31％（n = 805）。在多变量Cox比例风险回归模型中，LTFU风险增加与结核病史和基于d4T的ARV方案显着相关。 LTFU风险降低与HIV暴露，基线血红蛋白超过10g / dl和CD4> 50细胞/ mm3有关。在预测模型的开发中，显示了最高辨别力c统计量为0.63，最佳标定值为0.45的模型。在尼日利亚的艾滋病项目中，患者保留方面的挑战仍然至关重要。通过有效的治疗准备，更好的患者跟踪系统，疟疾和蠕虫病的预防性治疗（以解决贫血），促进HIV披露，提供者发起的活动性结核病例检测以及基于d4T的治疗方案的中止的早期治疗开始将有助于减少LTFU和改善免疫病毒学结果。

著录项

  • 作者

    Anude, Chuka Jide.;

  • 作者单位

    The Johns Hopkins University.;

  • 授予单位 The Johns Hopkins University.;
  • 学科 Health Sciences Medicine and Surgery.;Health Sciences Public Health.;Health Sciences Epidemiology.
  • 学位 Ph.D.
  • 年度 2011
  • 页码 289 p.
  • 总页数 289
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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