AIDS病人接受ART过程中失访的原因及对策

The reasons for lost to follow-up and countermeasures in AIDS patients with antiretroviral treatment

目的分析艾滋病(AIDS)病人接受抗病毒治疗(ART)中出现失访的原因,探讨降低失访率的对策。方法对深圳市第三人民医院艾滋病治疗数据管理系统自动生成的失访病人进行电话访谈,用自制表格记录临床资料,采用Logistic回归分析进行统计。结果在121例失访病人中,无效联系29例(24.0%),有效联系92例(76.0%)。有效联系者中,前3位失访原因为:药物不良反应49例(53.3%),工作原因22例(23.9%),抗拒服药12例(13.0%)。治疗3个月内的失访人数占失访总人数的71.1%(86/121),其中因药物不良反应在3个月内失访40人(81.6%),3个月后失访9人(18.4%),差异有统计学意义(P<0.05)。结论药物不良反应是AIDS病人在抗病毒治疗3个月内出现失访的主要原因,其次为工作原因和抗拒服药。应建立药物不良反应的告知机制,加强依从性教育,完善家庭与社会支持,优化用药方案,提高病人的服药依从性,降低失访率。

Objective To explore reasons and countermeasures for lost to follow-up in AIDS patients with antiretroviral therapy （ART）. Methods Telephone interviews were conducted in patients lost to follow-up,screened out by AIDS data management system of the hospital. Clinical data were collected using a homemade table and analyzed with logistic regression method. Results Among 121 patients lost to follow-up, 29（24%） were unable to contact, and 92 （76%） could contact effectively. The top 3 reasons lost to follow-up included drug side effects （49 cases, 53%）, change of work place （22 cases, 24%） and resistance to take medicine （12 cases, 13%）. Patients lost to follow up within the first 3 months accounted for 71.1% （86/121）. In respect of drug side effects, 40 （81.6%） were lost to follow up within the first 3 months, and 9 （18.4 %） were lost after 3 months of ART. The difference between them was statistically significant （P〈0. 05）. Conclusion The drug side effect was the main reason for lost to follow-up during the first 3 months after ART. , followed by change of work place and resistance to take medicine. In order to decrease the rate of loss to follow-up and increase medication adherence, it was important to establish inform mechanism of drug side effects, enhance education of medication adherence, improve family and society support, and optimize treatment protocols.