2005—2019年凉山州4县艾滋病抗病毒治疗脱失情况及其影响因素

Situation and determinants of loss to follow-up among HIV/AIDS patients under antiretroviral treatment in four counties of Liangshan prefecture,2005–2019

目的分析四川省凉山州4个艾滋病防治重点县(4县)抗病毒治疗(ART)脱失情况及其影响因素。方法采用回顾性队列研究方法,以4县2005—2019年入组治疗的艾滋病病毒感染者/病人(HIV/AIDS)为研究对象,随访观察至2020年底;从国家艾滋病综合防治信息系统收集病例报告、治疗及随访相关信息;采用寿命表法计算年度脱失概率和累计维持率,采用Cox比例风险回归模型进行影响治疗脱失的多因素分析。结果4县治疗总脱失率为14.82/人年,在治疗后的0~1、2~3、4~5、9~10年的脱失概率分别为18%、10%、7%和10%;多因素Cox比例风险回归模型结果显示女性治疗脱失风险低于男性(AHR=0.83),入组治疗时年龄≥40岁治疗脱失风险低于<30岁者(AHR=0.93);已婚或同居者脱失风险低于未婚者(AHR=0.85);与医疗机构来源相比,样本来源为重点人群者脱失风险较低(AHR=0.83);与治疗前合并感染HCV或HBV者相比,未合并感染者的脱失风险较低(AHR值分别为0.84、0.92);诊断感染HIV后≥1个月入组者脱失风险均高于<1个月入组者(1月~、6月~、12月~入组者AHR值分别为1.13、1.18和1.34);美姑县的脱失风险高于布拖县(AHR=3.83);相对2018年后入组者,2016、2017年间入组者脱失风险最低(AHR=0.5)。结论凉山4县治疗脱失率较高,脱失速度随治疗时间延长而下降,但从2018年起新入组治疗的脱失率有增加趋势;男性,<30岁,无配偶、经医疗机构检测发现、合并感染HCV或HBV、诊断后超过1个月启动治疗、现住址在美姑县是治疗脱失的危险因素。

Objective To analyze the situation and determinants of loss to follow-up among human immunodeficiency virus infection/acquired immunodeficiency syndrome(HIV/AIDS)patients under antireoviral treatment(ART)in four key counties of Liangshan prefecture,Sichuan province.Methods With retrospective cohort study design,we enrolled all HIV/AIDS patients(aged≥15 years)receiving ART during the period from 2005 through 2019 in 4 counties of Liangshan prefecture and conducted follow-ups of the patients untill the end of 2020.The patients′information on diagnosis and ART were extracted from National HIV/AIDS Comprehensive Information Management System.Life table method was used to calculate the annual rate of loss to follow-up and accummulated follow-up rate;Cox proportion hazard regression method was adopted to explore risk factors of loss to follow-up.Results The overall incidence rate of loss to follow-up was 14.82per 100 person-years among all patients;the rate of loss to follow-up at the 1st,3r,fifth,and the 10th year were 18%,10%,7%,and 10%,respectively.The multivariate Cox proportional hazard regression model showed that the patients with following characteristics were at a decreased risk of loss to follow-up:a)being female(versus male:adjusted hazard risk[aHR]=0.83),b)aged≥40 years(versus<30 years:aHR=0.93),c)being married or cohabitating(versus single:aHR=0.85),d)being screened out from high risk populations(versus being diagnosed when attending medical services:aHR=0.83),e)without co-infection of hepatitis C virus(HCV)or hepatitis B virus(HBV)(versus with HCV:aHR=0.84 or with HBV:aHR=0.92),and f)having the initiative ART during 2016 or 2017(versus during 2018:aHR=0.5);while,the patients having the initiative ART 1–5,6–11,and≥12 months after the confirmation of HIV infection were at an increased risk of loss to follow-up,with the aHR of 1.13,1.18,and 1.34 compared to those having the initiative ART less than one month after the diagnosis.The patients′risk of loss to follow-up differed by their living region and the patients in one of the four counties had the highest risk(aHR=3.83)compared to the patients in the other counties.Conclusion The incidence rate of loss to follow-up was relatively high in four counties of Liangshan prefecture;the rate decreased with the extension of ART treatment and the rate increased after 2018.Male gender,aged less than 30 years,being single,being diagnosed when attending medical service,with the co-infection of HCV or HBV,having the initiative ART more than one month after confirmed diagnosis were risk factors of loss to follow-up in the patients.