乌干达艾滋病毒成人的脏病查:高风险人口的错过优先事项
medRxiv : the preprint server for health sciences
|August 20, 2025
概括
乌干达艾滋病毒感染者的脏疾病查非常低,特别是在农村地区. 没有遵循国家指导方针,显示出政策与实践之间的差距.
科学领域:
- 公共卫生 公共卫生
- 腎臟病學 (nephrology) 是一種醫學專業.
- 传染性疾病 传染性疾病
背景情况:
- 慢性病 (CKD) 影响全球8.5亿人,撒哈拉以南非洲地区受到了不成比例的影响.
- 艾滋病毒感染者 (PWH) 由于抗逆转录病毒疗法 (ART) 诱导的毒性,特别是由于tenofovir disoproxil fumarate (TDF) 引起的慢性病风险较高.
- 乌干达的国家指导方针要求在ART启动时进行常规脏病查,以检测PWH.
研究的目的:
- 评估在乌干达开始ART的成年人中遵守国家脏病查指南.
- 评估病查率的趋势随着时间的推移,跨越不同的指南时代.
- 在ART启动时识别与脏疾病查相关的因素.
主要方法:
- 从2017年至2024年期间在乌干达三个艾滋病毒诊所启动ART的17,485名成年人的临床数据的回顾性分析.
- 数据根据国家指导方针的变化被分为三个时代:测试和治疗 (2017-2019),DTG推出/COVID-19 (2020-2022) 和所有人的肌素 (2023-2024).
- 用于确定脏查相关的物流回归模型.
主要成果:
- 整体病查率较低,为22.4% (3,909/17,485人).
- 查率因地点而异:城市诊所的54.2%,农村诊所的10.0%.
- 在农村地区,随着时间的推移,查的可能性下降了83%,在"全人氨酸"时代 (aOR 0.17) 的可能性降低了83%. 相反,城市查增加了 (aOR 9.27). 男性性别,年龄较大,高血压和非TDFART与农村地区更高的查几率有关.
结论:
- 乌干达在ART启动时对脏疾病的查不足,特别是在农村环境中,这表明实施面临重大挑战.
- 国家指导方针与临床实践之间存在严重差距,特别是在资源有限的农村地区.
- 需要进一步的研究,以了解障碍,并制定有效的策略,以改善准则的遵守和脏疾病查的吸收.
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