科研之友
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摘要
Objectives: In developing nations, the use of operational parameters (OPs) in the prediction of clinical care represents a missed opportunity to enhance the care process. We modeled the impact of multiple measurements of antiretroviral treatment (ART) adherence on antiretroviral treatment outcomes in Peru. %26lt;br%26gt;Design And Methods: Retrospective cohort study including ART naive, non-pregnant, adults initiating therapy at Hospital Nacional Cayetano Heredia, Lima-Peru (2006-2010). Three OPs were defined: 1) Medication possession ratio (MPR): days with antiretrovirals dispensed/days on first-line therapy; 2) Laboratory monitory constancy (LMC): proportion of 6 months intervals with %26gt;= 1 viral load or CD4 reported; 3) Clinic visit constancy (CVC): proportion of 6 months intervals with %26gt;= 1 clinic visit. %26lt;br%26gt;Three multi-variable Cox proportional hazard (PH) models (one per OP) were fit for (1) time of first-line ART persistence and (2) time to second-line virologic failure. All models were adjusted for socio-demographic, clinical and laboratory variables. %26lt;br%26gt;Results: 856 patients were included in first-line persistence analyses, median age was 35.6 years [29.4-42.9] and most were male (624; 73%). In multivariable PH models, MPR (per 10% increase HR=0.66; 95% CI=0.61-0.71) and LMC (per 10% increase 0.83; 0.71-0.96) were associated with prolonged time on first-line therapies. %26lt;br%26gt;Among 79 individuals included in time to second-line virologic failure analyses, MPR was the only OP independently associated with prolonged time to second-line virologic failure (per 10% increase 0.88; 0.77-0.99). %26lt;br%26gt;Conclusions: The capture and utilization of program level parameters such as MPR can provide valuable insight into patient-level treatment outcomes.
- 出版日期2013-10-1
- 单位河北医科大学
