Diminishing Availability of Publicly Funded Slots for Antiretroviral Initiation among HIV-Infected ART-Eligible Patients in Uganda 英文参考文献.docVIP

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Diminishing Availability of Publicly Funded Slots for Antiretroviral Initiation among HIV-Infected ART-Eligible Patients in Uganda 英文参考文献.doc

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Diminishing Availability of Publicly Funded Slots for Antiretroviral Initiation among HIV-Infected ART-Eligible Patients in Uganda 英文参考文献

DiminishingAvailabilityofPubliclyFundedSlotsfor AntiretroviralInitiationamongHIV-InfectedART-Eligible PatientsinUganda ElvinH.Geng1,5,MwebesaB.Bwana4,5,JeromeKabakyenga4,WinnieMuyindike4,5,NnekaI. Emenyonu3,4,NicholasMusinguzi4,5,PeterMugyenyi4,JeffreyN.Martin1,2,5,DavidR.Bangsberg3,4,5 * 1DivisionofHIV/AIDS,DepartmentofMedicine,SanFranciscoGeneralHospital,SanFrancisco,California,UnitedStatesofAmerica,2DepartmentofEpidemiologyand Biostatistics,UniversityofCaliforniaSanFrancisco,SanFrancisco,California,UnitedStatesofAmerica,3RagonInstituteofMassachusettsGeneralHospital,Massachusetts InstituteofTechnologyandHarvard,MassachusettsGeneralHospitalCenterforGlobalHealth,HarvardMedicalSchool,Boston,Massachusetts,UnitedStatesofAmerica, 4MbararaUniversityofScienceandTechnology,Mbarara,Uganda,5TheEastAfricaInternationalDatabasestoEvaluateAIDSConsortium Abstract Background:Theimpactofflat-linefundingintheglobalscaleupofantiretroviraltherapy(ART)forHIV-infectedpatientsin Africahasnotyetbeenwelldescribed. Methods: We evaluated ART-eligible patients and patients starting ART at a prototypical scale up ART clinic in Mbarara, UgandabetweenApril1,2009andMay14,2010wherefourstakeholderssponsortreatment–twoPEPFARimplementing organizations, the Ugandan Ministry of Health – Global Fund (MOH-GF) and a private foundation named the Family Treatment Fund (FTF). We assessed temporal trends in the number of eligible patients, the number starting ART and tabulatedthedistributionofthestakeholderssupportingARTinitiationbymonthandquartileoftimeduringthisinterval. WeusedsurvivalanalysestoassesschangesintherateofARTinitiationovercalendartime. Findings:Atotalof1309patientswhowereeligibleforARTmadevisitsoverthe14monthperiodofthestudyandofthese 819startedART.ThemediannumberofARTeligiblepatientseachmonthwas88(IQR:74to115).Byquartileofcalendar time,PEPFARandMOHsponsored290,192,180,and49ARTinitiationswhereastheFTFstarted1,2,1and104patients respectively.ByMayof2010(thelastcalendarmonthofobservation)FTFspon