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首页> 外文期刊>World Journal of AIDS >Challenges in Retention of Patients in Continuum of HIV-Care in Delhi— Experience of a Decade & Way Ahead
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Challenges in Retention of Patients in Continuum of HIV-Care in Delhi— Experience of a Decade & Way Ahead

机译：在德里，在进行艾滋病毒/艾滋病护理的过程中保留患者的挑战—十年的经验和未来之路

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Retention of the patients in HIV-care is critical for success of Anti Retroviral Treatment (ART) programme to reduce HIV-related morbidity & mortality and prevent emergence of drug resistance. In last decade in Delhi (April 2004 to March 2014), overall 24% HIV-positive patients were lost-to-follow-up (LTFU) at step-1 (testing to enrolment into HIV-care), 7.8% at step-2 (enrolment to ART eligibility), 23.7% at step-3 (eligibility to initiation of ART) and 16.6% at step-4 (initiation to lifelong ART) of retention cascade. About 2/3rd losses at step-4 were within 1st year and 80% within 2 years. The retention of the patients in pre-ART care was 3 times lower than those initiated ART. Only 27.4% patients were in active pre-ART care during 2013. The intensified LTFU tracking (ILT) undertaken during November, 2013 through March, 2014 was not successful in tracking 97% pre-ART LTFU clients due to incomplete addresses/or migration since address proof of patients on enrolment into HIV-care was not mandatory prior to 2009. Amongst patients tracked, 1.5% were alive, 0.24% had disengaged from care while 1.2% had died. After ILT overall “On ART” and “Pre-ART” LTFU rate in the last decade was 15.5% and 45.2%, respectively. The retention cascade of last year from April 2013 to March 2014 showed improvement through strategies adopted in Third Phase of National AIDS Control Programme (NACP-III; 2007-2013), and “On ART” and “Pre-ART” LTFU rates declined to 9.4% and 7.4%, respectively. However, desired at least 90% retention at various steps of the cascade could not be achieved. National Policy of delivering ART services through limited number of standalone ART centers in India, despite its significant success, has limitation of leaky treatment cascade and calls for policy makers to decentralize the programme by its appropriate integration with general health services and task shifting to improve continuum of care.
机译：将患者保留在HIV护理中对于成功开展抗逆转录病毒治疗（ART）计划至关重要，该计划旨在降低与HIV相关的发病率和死亡率，并防止出现耐药性。在德里的最近十年（2004年4月至2014年3月）中，第1步（经测试加入HIV护理）的整体24％HIV阳性患者失访（LTFU），为7.8在第2步（加入ART资格）的百分比，在第3步（开始ART的资格）的23.7％和在第4步（终身ART的发起）的保留级联的23.7％。在第4步中，大约有2/3的损失在第一年之内，而在2年之内为80％。患者接受抗逆转录病毒治疗之前的保留时间比开始抗逆转录病毒治疗的患者低3倍。在2013年期间，只有27.4％的患者接受过有效的ART术前护理。由于地址不完整，2013年11月至2014年3月进行的强化LTFU跟踪（ILT）未能成功跟踪97％的ART LTFU患者/或迁移，因为在2009年之前没有强制要求提供入院HIV治疗的地址证明。在接受追踪的患者中，有1.5％活着，有0.24％的患者脱离了护理，而有1.2％的患者死亡。在ILT之后，过去十年中，“ On ART”和“ Pre-ART”的LTFU总体比率分别为15.5％和45.2％。去年2013年4月至2014年3月的保留级联表明，通过国家艾滋病控制计划（NACP-III; 2007-2013）第三阶段采用的策略有所改善，“ On ART”和“ ART-Pre” LTFU比率下降至分别为9.4％和7.4％。然而，在级联的各个步骤上不能实现期望的至少90％的保留。通过印度数量有限的独立抗病毒治疗中心提供抗病毒治疗服务的国家政策尽管取得了巨大成功，但仍然存在泄漏治疗级联的局限性，并呼吁政策制定者通过将其与一般卫生服务适当整合和转移任务来分散该计划的权力，以改善连续性的照顾。

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