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Mesele M, Asmare G, Ambaw G, Asmamaw M, Abdu M, Chekol E, Tenaw D, Fenta S, Asmamaw T, Aderajew M, Mengist A, Solomon Y, Bantie B, Alebachew W, Atnafu N. Correlates of ART attrition among adults under antiretroviral therapy in Southern Ethiopia, retrospective cohort study. AIDS Care 2023:1-8. [PMID: 38157365 DOI: 10.1080/09540121.2023.2293758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
High attrition rates from ART are the primary contributors to morbidity, death, hospitalisation, rising transmission rates, treatment failure, rising burden of opportunistic infections (OIs), and the evolution of HIV-virus resistance (HIVDR). In Sub-Saharan Africa, more than two-thirds of ART patients will not receive continuous care. There is little information about the correlates that contribute to attrition from ART services among ART patients in Southern Ethiopia. Hence, this study aims to identify correlates of attrition from antiretroviral therapy services for adults under antiretroviral therapy at Otona Teaching and Referral Hospital, Wolaita Zone, Southern Ethiopia. From 1 January 2013 to 31 December 2017, a retrospective cohort analysis was performed. The pre-determined 328 medical records were chosen using a simple random sampling technique using computer-generated random numbers. Epi Info version 3.5.3 was used to enter and clean the data, which were then exported to STATA version 11 for analysis. The Cox proportional hazards model, both bivariate and multivariable, was used. Variables with p-values less than 0.25 in bivariate analysis were considered candidates for multivariable analysis, and variables with p-values less than 0.05 were deemed statistically important in multivariable analysis. The intensity of the correlation and statistical significance were determined using the CHR, AHR, and 95 per cent confidence intervals. The magnitude of attrition from ART service was 21.60% (95% CI: 17.10, 26.10). The distance between home and hospital is more than five kilometres (AHR:3.84;95% CI: 1.99,7.38), no registered phone number (AHR:2.47;95%CI:1.32,4.09), have not taken isoniazid prophylaxis (AHR:2.23;95%CI:1.30,4.09), alcohol consumption (AHR: 1.77; 95% CI:1.01, 3.12), and had no caregiver (AHR: 2.11; 95% CI:1.23, 3.60) were statistically significant in the Cox proportional hazard model. Distance between home and hospital, phone number registration on follow-up chart, having a history of alcohol consumption, isoniazid prophylaxis provision, and having family support were independent correlates of attrition from antiretroviral treatment services.
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Affiliation(s)
- Molalegn Mesele
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Getachew Asmare
- Department of Reproductive Health and Nutrition, School of Public Health, Woliata Sodo University, Sodo, Ethiopia
| | - Gizachew Ambaw
- Department of Epidemiology and Biostatistics, School of Public Health, Woliata Sodo University, Sodo, Ethiopia
| | - Misganaw Asmamaw
- Department of Biochemistry, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mohammed Abdu
- Unit of Physiology, Department of Biomedical Science, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Endeshaw Chekol
- Department of Medical Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Denekew Tenaw
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sefineh Fenta
- Department of Public Health, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Tadesse Asmamaw
- Department of Medical Biochemistry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melkamu Aderajew
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Anteneh Mengist
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yenealem Solomon
- Department of Medical Laboratory Science, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Berihun Bantie
- Department of Comprehensive Nursing, College of Health sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew
- Department of Maternal and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Natnael Atnafu
- School of Midwifery, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
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Predictors of retention in the prospective HIV prevention OKAPI cohort in Kinshasa. Sci Rep 2021; 11:5431. [PMID: 33686218 PMCID: PMC7970874 DOI: 10.1038/s41598-021-84839-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 02/15/2021] [Indexed: 11/08/2022] Open
Abstract
Retention is a key element in HIV prevention programs. In Sub-Saharan Africa most data on retention come from HIV clinical trials or people living with HIV attending HIV treatment and control programs. Data from observational cohorts are less frequent. Retention at 6-/12-month follow-up and its predictors were analyzed in OKAPI prospective cohort. From April 2016 to April 2018, 797 participants aged 15-59 years attending HIV Voluntary Counseling and Testing in Kinshasa were interviewed about HIV-related knowledge and behaviors at baseline and at 6- and 12-month follow-ups. Retention rates were 57% and 27% at 6- and 12-month follow up; 22% of participants attended both visits. Retention at 6-month was significantly associated with 12-month retention. Retention was associated with low economic status, being studying, daily/weekly Internet access, previous HIV tests and aiming to share HIV test with partner. Contrarily, perceiving a good health, living far from an antiretroviral center, daily/weekly alcohol consumption and perceiving frequent HIV information were inversely associated with retention. In conclusion, a high attrition was found among people attending HIV testing participating in a prospective cohort in Kinshasa. Considering the low retention rates and the predictors found in this study, more HIV cohort studies in Kinshasa need to be evaluated to identify local factors and strategies that could improve retention if needed.
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Tymejczyk O, Vo Q, Kulkarni SG, Antelman G, Boshe J, Reidy W, Parcesepe A, Nash D, Elul B. Tracing-corrected estimates of disengagement from HIV care and mortality among patients enrolling in HIV care without overt immunosuppression in Tanzania. AIDS Care 2019; 33:47-53. [PMID: 31826640 DOI: 10.1080/09540121.2019.1699642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
In the era of "test and treat", it is important to understand HIV care outcomes and their determinants in patients presenting to care with early-stage disease. We surveyed 924 adults newly enrolling in HIV care at four clinics in Tanzania before the adoption of universal treatment eligibility, and collected longitudinal clinical data. Participants who defaulted from care were tracked in the community. Cumulative incidence of disengagement from care and death was estimated using competing risk methods. By 12 months after enrollment, 18.2% of patients had disengaged from care and 6.9% had died. Factors associated with disengagement included male sex (adjusted subhazard ratio [aSHR] versus female = 1.75, 95% confidence interval [CI]: 1.06-2.89), provider-initiated HIV diagnosis (aSHR versus self-referred = 1.71, 95% CI: 1.03-2.86), ineligibility for antiretroviral treatment (ART) at enrollment (aSHR versus eligibility = 2.82, 95% CI: 1.84-4.32) and increased anticipated stigma score (aSHR = 1.04 per 5-point increase, 95% CI: 1.02-1.05). Higher life satisfaction score (aSHR = 0.97 per 5-point increase, 95% CI: 0.95-0.99) and having 1-2 close friends (aSHR versus none = 0.58, 95% CI: 0.47-0.71) were protective. The findings highlight the continued importance of social environment for HIV care outcomes and the potential of universal ART eligibility to reduce HIV care attrition.
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Affiliation(s)
- Olga Tymejczyk
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA.,Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Quynh Vo
- ICAP, Columbia University, New York, NY, USA
| | - Sarah Gorrell Kulkarni
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA.,Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA.,ICAP, Columbia University, New York, NY, USA
| | | | | | - William Reidy
- ICAP, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Angela Parcesepe
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA.,Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Batya Elul
- ICAP, Columbia University, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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Fayorsey RN, Wang C, Chege D, Reidy W, Syengo M, Owino SO, Koech E, Sirengo M, Hawken MP, Abrams EJ. Effectiveness of a Lay Counselor-Led Combination Intervention for Retention of Mothers and Infants in HIV Care: A Randomized Trial in Kenya. J Acquir Immune Defic Syndr 2019; 80:56-63. [PMID: 30399035 PMCID: PMC6319592 DOI: 10.1097/qai.0000000000001882] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 09/27/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Retention of mothers and infants across the prevention of mother-to-child HIV transmission (PMTCT) continuum remains challenging. We assessed the effectiveness of a lay worker administered combination intervention compared with the standard of care (SOC) on mother-infant attrition. METHODS HIV-positive pregnant women starting antenatal care at 10 facilities in western Kenya were randomized using simple randomization to receive individualized health education, retention/adherence support, appointment reminders, and missed visit tracking vs. routine care per guidelines. The primary endpoint was attrition of mother-infant pairs at 6 months postpartum. Attrition was defined as the proportion of mother-infant pairs not retained in the clinic at 6 months postpartum because of mother or infant death or lost to follow-up. Intent-to-treat analysis was used to assess the difference in attrition. This trial is registered with ClinicalTrials.gov; NCT01962220. RESULTS From September 2013 to June 2014, 361 HIV-positive pregnant women were screened, and 340 were randomized to the intervention (n = 170) or SOC (n = 170). Median age at enrollment was 26 years (interquartile range 22-30); median gestational age was 24 weeks (interquartile range 17-28). Overall attrition of mother-infant pairs was 23.5% at 6 months postpartum. Attrition was significantly lower in the intervention arm compared with SOC (18.8% vs. 28.2%, relative risk (RR) = 0.67, 95% confidence interval: 0.45 to 0.99, P = 0.04). Overall, the proportion of mothers who were retained and virally suppressed (<1000 copies/mL) at 6 months postpartum was 54.4%, with no difference between study arms. CONCLUSIONS Provision of a combination intervention by lay counselors can decrease attrition along the PMTCT cascade in low-resource settings.
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Affiliation(s)
- Ruby N. Fayorsey
- Department of Epidemiology, ICAP at Columbia University, Mailman School of Public Health, New York, NY
| | - Chunhui Wang
- Department of Epidemiology, ICAP at Columbia University, Mailman School of Public Health, New York, NY
| | - Duncan Chege
- ICAP Kenya, Columbia University, Mailman School of Public Health, New York, NY
| | - William Reidy
- Department of Epidemiology, ICAP at Columbia University, Mailman School of Public Health, New York, NY
| | - Masila Syengo
- ICAP Kenya, Columbia University, Mailman School of Public Health, New York, NY
| | | | - Emily Koech
- ICAP Kenya, Columbia University, Mailman School of Public Health, New York, NY
- Currently, PACT Endeleza, University of Maryland, Maryland, Baltimore
- Kenya Program, Nairobi, Kenya
| | - Martin Sirengo
- National AIDS and STI Control Program, Nairobi, Kenya; and
| | - Mark P. Hawken
- ICAP Kenya, Columbia University, Mailman School of Public Health, New York, NY
| | - Elaine J. Abrams
- Department of Epidemiology, ICAP at Columbia University, Mailman School of Public Health, New York, NY
- College of Physicians and Surgeons, Columbia University, New York, NY
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Dareng EO, Olaniyan Y, Adebamowo SN, Eseyin OR, Odutola MK, Obiefuna EM, Offiong RA, Pharoah PP, Adebamowo CA. Age, HIV status, and research context determined attrition in a longitudinal cohort in Nigeria. J Clin Epidemiol 2018; 100:32-43. [PMID: 29679747 PMCID: PMC8015251 DOI: 10.1016/j.jclinepi.2018.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/03/2018] [Accepted: 04/11/2018] [Indexed: 01/12/2023]
Abstract
OBJECTIVES We explored determinants of attrition in a longitudinal cohort study in Nigeria. STUDY DESIGN AND SETTING We enrolled 1,020 women into a prospective study. Of these, 973 were eligible to return for follow-up. We investigated the determinants of attrition among eligible women using a sequential mixed methods design. We used logistic regression models to compare the baseline characteristics of responders and nonresponders. At the end of the parent study, we conducted four focus group discussions and eight key informant interviews with nonresponders. RESULTS Of the 973 women included in the quantitative analysis, 26% were nonresponders. From quantitative analysis, older women were less likely to drop out than younger women (reference: women ≤30 years; OR 0.46; 95% confidence interval [CI] 0.30-0.70, P < 0.001 women 31-44 years; and OR 0.31; 95% CI 0.17-0.56, P < 0.001 women ≥45 years). HIV-positive women were also less likely to drop out of the study (OR 0.45; 95% CI 0.33-0.63, P < 0.001). From qualitative analysis, contextual factors that influenced attrition were high cost of participation, therapeutic misconceptions, inaccurate expectations, spousal disapproval, unpleasant side effects, challenges in maintaining contact with participants, and participant difficulties in locating the study clinic. CONCLUSION Several participant-, research-, and environment-related factors influence attrition. Retention strategies that address these barriers are important to minimize attrition.
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Affiliation(s)
- Eileen O Dareng
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom; Office of Strategic Information, Research and Training, Institute of Human Virology, Abuja, Nigeria
| | - Yinka Olaniyan
- Department of Obstetrics and Gynecology, National Hospital, Abuja, Nigeria
| | - Sally N Adebamowo
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA; Marlene and Stewart Greenbaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Olabimpe R Eseyin
- Office of Strategic Information, Research and Training, Institute of Human Virology, Abuja, Nigeria
| | - Michael K Odutola
- Office of Strategic Information, Research and Training, Institute of Human Virology, Abuja, Nigeria
| | - Elonna M Obiefuna
- Office of Strategic Information, Research and Training, Institute of Human Virology, Abuja, Nigeria
| | - Richard A Offiong
- Department of Obstetrics and Gynecology, University of Abuja Teaching Hospital, Abuja, Nigeria
| | - Paul P Pharoah
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Clement A Adebamowo
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA; Marlene and Stewart Greenbaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD, USA; Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
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Reepalu A, Balcha TT, Sturegård E, Medstrand P, Björkman P. Long-term Outcome of Antiretroviral Treatment in Patients With and Without Concomitant Tuberculosis Receiving Health Center-Based Care-Results From a Prospective Cohort Study. Open Forum Infect Dis 2017; 4:ofx219. [PMID: 29226173 PMCID: PMC5714222 DOI: 10.1093/ofid/ofx219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 09/28/2017] [Indexed: 02/02/2023] Open
Abstract
Background In order to increase treatment coverage, antiretroviral treatment (ART) is provided through primary health care in low-income high-burden countries, where tuberculosis (TB) co-infection is common. We investigated the long-term outcome of health center-based ART, with regard to concomitant TB. Methods ART-naïve adults were included in a prospective cohort at Ethiopian health centers and followed for up to 4 years after starting ART. All participants were investigated for active TB at inclusion. The primary study outcomes were the impact of concomitant TB on all-cause mortality, loss to follow-up (LTFU), and lack of virological suppression (VS). Kaplan-Meier survival estimates and Cox proportional hazards models with multivariate adjustments were used. Results In total, 141/729 (19%) subjects had concomitant TB, 85% with bacteriological confirmation (median CD4 count TB, 169 cells/mm3; IQR, 99-265; non-TB, 194 cells/mm3; IQR, 122-275). During follow-up (median, 2.5 years), 60 (8%) died and 58 (8%) were LTFU. After ≥6 months of ART, 131/630 (21%) had lack of VS. Concomitant TB did not influence the rates of death, LTFU, or VS. Male gender and malnutrition were associated with higher risk of adverse outcomes. Regardless of TB co-infection status, even after 3 years of ART, two-thirds of participants had CD4 counts below 500 cells/mm3. Conclusions Concomitant TB did not impact treatment outcomes in adults investigated for active TB before starting ART at Ethiopian health centers. However, one-third of patients had unsatisfactory long-term treatment outcomes and immunologic recovery was slow, illustrating the need for new interventions to optimize ART programs.
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Affiliation(s)
| | - Taye Tolera Balcha
- Clinical Infection Medicine.,Clinical Virology, Department of Translational Medicine, Lund University, Sweden
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Bucciardini R, Fragola V, Abegaz T, Lucattini S, Halifom A, Tadesse E, Berhe M, Pugliese K, Fucili L, Gregorio MD, Mirra M, Castro PD, Terlizzi R, Tatarelli P, Binelli A, Zegeye T, Campagnoli M, Vella S, Abraham L, Godefay H. Predictors of attrition from care at 2 years in a prospective cohort of HIV-infected adults in Tigray, Ethiopia. BMJ Glob Health 2017; 2:e000325. [PMID: 29082011 PMCID: PMC5656181 DOI: 10.1136/bmjgh-2017-000325] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/17/2017] [Accepted: 06/29/2017] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Ethiopia has experienced rapid expansion of antiretroviral therapy (ART). However, as long-term retention in ART therapy is key for ART effectiveness, determinants of attrition need to be identified so appropriate interventions can be designed. METHODS We used data from the 'Cohort of African people Starting Antiretroviral therapy' (CASA) project, a prospective study of a cohort of HIV-infected patients who started ART in seven health facilities (HFs). We analysed the data of patients who had started first-line ART between January 2013 and December 2014. The Kaplan-Meier method was used to estimate the probability of retention at different time points. The Cox proportional hazards model was used to identify factors associated with attrition. RESULTS A total of 1198 patients were included in the study. Kaplan-Meier estimates of retention in care were 83.9%, 82.1% and 79.8% at 12, 18 and 24 months after starting ART, respectively. Attrition was mainly due to loss to follow-up, transferred-out patients and documented mortality. A multivariate Cox proportional hazard model showed that male sex, CD4 count <200 cells/µL and the type of HF were significantly associated with attrition. CONCLUSIONS The observed attrition differences according to gender suggest that separate interventions designed for women and men should be explored. Moreover, innovative strategies to increase HIV testing should be supported to avoid CD4 levels falling too low, a factor significantly associated with higher attrition in our study. Finally, specific studies to analyse the reasons for different levels of attrition among HFs are required.
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Affiliation(s)
| | | | - Teshome Abegaz
- College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | | | | | - Eskedar Tadesse
- College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Micheal Berhe
- College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | | | | | | | | | | | | | - Paola Tatarelli
- Department of Infectious Diseases, Università degli studi di Genova, Genoa, Italy
| | | | - Teame Zegeye
- Tigray Regional Health Bureau, Mekelle, Ethiopia
| | | | | | - Loko Abraham
- College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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