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Treatment retention and care transitions during and after the scale-up of HIV care and treatment in Northern Tanzania

机译：在坦桑尼亚北部扩大HIV护理和治疗的过程中和之后的治疗保留和护理过渡

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Decentralization of HIV care is promoted to improve access to antiretroviral therapy in sub-Saharan Africa. This study describes care transitions among HIV-infected persons in Northern Tanzania during a period of rapid decentralization of HIV care and treatment centers (CTCs) from hospitals to local health centers. Between November 2008 and June 2009, 492 HIV-infected patients in established care at two referral hospitals in Moshi, Tanzania, and 262 persons newly diagnosed with HIV were selected for participation in a prospective cohort study entitled Coping with HIV/AIDS in Tanzania. Clinical records and participant self-reports, collected between June and November 2012, were used to describe retention in care and transitions between CTCs during the study period. After a mean follow-up period of 3.5 years, 10% of participants had died, 9% were lost to follow-up, and 11% had moved. Of the remaining participants enrolled from CTCs, more than 90% reported at least one CTC visit during the previous six months, with 98% still in care at the CTC at which they were enrolled. Nearly three out of four newly diagnosed clients listed a referral hospital as their primary CTC. Fewer than 10% of participants ever sought care at another CTC in the study area; nearly 90% of those in care bypassed their closest CTC. Administrative data from all facilities in the study area indicate that new clients, even after the scale-up from 8 CTCs in 2006 to 21 CTCs in 2008, disproportionately selected established CTCs, and client volume at newly approved facilities was highly variable. Despite the decentralization of HIV care and treatment in this setting, many patients continue to bypass their closest CTC to seek care at established facilities. Patient preferences for decentralized HIV care, which may inform optimal resource utilization, are largely unknown and warrant further investigation.
机译：在撒哈拉以南非洲，艾滋病毒保健的分权得到促进，以改善获得抗逆转录病毒疗法的机会。这项研究描述了在从医院到当地医疗中心的艾滋病护理和治疗中心（CTC）快速下放期间，坦桑尼亚北部艾滋病毒感染者之间的护理过渡。在2008年11月至2009年6月之间，选择了492例在坦桑尼亚莫希的两家转诊医院接受常规治疗的HIV感染患者，以及262名新诊断为HIV的患者参加了一项针对坦桑尼亚的前瞻性队列研究。 2012年6月至11月之间收集的临床记录和参与者的自我报告被用来描述研究期间护理的保留和CTC之间的过渡。在平均3.5年的随访期之后，有10％的参与者死亡，有9％的参与者失去随访，而11％的参与者搬家了。在来自CTC的其余参与者中，超过90％的人表示在过去六个月中至少进行了一次CTC访问，而98％的参与者仍在他们参加的CTC的照护中。四分之三的新诊断客户将转诊医院作为他们的主要CTC。不到10％的参与者曾经在研究区域的另一个CTC寻求过护理;近90％的被护理者绕过了最接近的CTC。研究区域所有设施的管理数据表明，即使从2006年的8个CTC扩大到2008年的21个CTC之后，新客户的选择仍然不成比例，而且新批准设施的客户数量变化很大。尽管在这种情况下将艾滋病毒的治疗和治疗分散化，但许多患者仍绕过其最接近的CTC在既有设施寻求治疗。病人对分散式HIV护理的偏好（可能有助于最佳利用资源）在很大程度上尚不清楚，需要进一步调查。

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