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Multiple gaps in care common among newly diagnosed HIV patients

机译：新诊断的艾滋病毒患者在医疗保健中存在多个差距

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The objective of this study was to identify frequency and predictors of gaps in care in a longitudinal cohort of HIV-infected patients in urban New England. We conducted a retrospective cohort study in Providence, RI, of 581 newly diagnosed HIV patients >18 entering into care from 2004 to 2010, and followed their care through the end of 2011. The outcome of interest was gaps in care, defined as an interruption of medical care for >6 months. Time to the first gap was characterized using Kaplan-Meier (KM) curves. Anderson-Gill proportional hazards (AGPH) model was used to identify the risk factors of recurrent gaps in care. During the study period, 368 patients (63%) experienced at least 1 gap in care, 178 (30%) had >= 2 gaps, 84 (14.5%) had >= 3 gaps, and 21 (3.6%) died; 77% of the gaps were followed by a re-linkage with care The KM curves estimate that one-quarter of patients (95% CI = 22-29%) would experience >= 1 gap in care by Year 1; nearly one-half (CI = 45-54%) by Year 2; and 90% (CI = 93-96%) by Year 8. A prior gap was a strong predictor (HR = 2.36; CI = 2.16-2.58) of subsequent gaps; other predictors included age <25 (HR = 1.29; CI = 1.04-1.60), and no prescription of ART in first year of care (HR = 1.23; CI = 1.01-1.50). The results of this study suggest that a significant proportion of newly diagnosed HIV-infected patients will experience multiple gaps in care and yet re-engagement is possible. Interventions should focus on both prevention of gaps as well as re-engaging those lost to follow-up.
机译：这项研究的目的是确定在新英格兰城市的HIV感染患者的纵向队列中，服务差距的频率和预测因素。我们在罗德岛州普罗维登斯市进行了一项回顾性队列研究，研究对象是从2004年至2010年进入护理领域的581例新诊断为HIV的18岁以上艾滋病患者，并一直追踪到2011年底。关注的结果是护理方面的差距，定义为中断> 6个月的医疗服务。使用Kaplan-Meier（KM）曲线表征到达第一间隙的时间。使用安德森-吉尔比例风险（AGPH）模型来确定经常性护理缺口的风险因素。在研究期间，有368名患者（63％）经历了至少1个护理间隙，178名（30％）有≥2个间隙，84名（14.5％）≥3个间隙，21名（3.6％）死亡。 77％的差距之后是与护理的重新关联。KM曲线估计，到第一年，四分之一的患者（95％CI = 22-29％）将经历大于等于1的护理差距;到第二年将近一半（CI = 45-54％）;到第8年时，这一比例为90％（CI = 93-96％）。先前的差距是后续差距的有力预测指标（HR = 2.36; CI = 2.16-2.58）。其他预测因素包括年龄<25岁（HR = 1.29; CI = 1.04-1.60），并且在护理的第一年没有处方抗逆转录病毒疗法（HR = 1.23; CI = 1.01-1.50）。这项研究的结果表明，新诊断的HIV感染患者中有很大一部分将在护理方面出现多个差距，但仍可能重新参与。干预措施应侧重于防止差距以及重新参与后续行动中失去的差距。

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