better antiretroviral therapy outcomes at primary healthcare facilities an evaluation of three tiers of art services in four south african provinces在初级卫生保健设施更好的抗逆转录病毒治疗结果进行评估,三层在南非四省的艺术服务.pdfVIP

Better Antiretroviral Therapy Outcomes at Primary Healthcare Facilities: An Evaluation of Three Tiers of ART Services in Four South African Provinces 1,2 1 1,3 Geoffrey Fatti *, Ashraf Grimwood , Peter Bock 1 Kheth’Impilo, Cape Town, South Africa, 2 Lung Clinical Research Unit, University of Cape Town Lung Institute, Cape Town, South Africa, 3 Primary Healthcare Directorate, University of Cape Town, Cape Town, South Africa Abstract Background: There are conflicting reports of antiretroviral therapy (ART) effectiveness comparisons between primary healthcare (PHC) facilities and hospitals in low-income settings. This comparison has not been evaluated on a broad scale in South Africa. ¨ Methodology/Principal Findings: A retrospective cohort study was conducted including ART-naıve adults from 59 facilities in four provinces in South Africa, enrolled between 2004 and 2007. Kaplan-Meier estimates, competing-risks Cox regression, generalised estimating equation population-averaged models and logistic regression were used to compare death, loss to follow-up (LTFU) and virological suppression (VS) between PHC, district and regional hospitals. 29 203 adults from 47 PHC facilities, nine district hospitals and three regional hospitals were included. Patients at PHC facilities had more advanced WHO stage disease when starting ART. Retention in care was 80.1% (95% CI: 79.3%–80.8%), 71.5% (95% CI: 69.1%–73.8%) and 68.7% (95% CI: 67.0%–69.7%) at PHC, district and regional hospitals respectively, after 24 months of treatment (P,0.0001). In adjusted regression analyses, LTFU was