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Stolka K, Iriondo-Perez J, Kiumbu M, Atibu J, Azinyue I, Akam W, Balimba A, Mfangam Molu B, Mukumbi H, Niyongabo T, Twizere C, Newman J, Hemingway-Foday J. Characteristics of antiretroviral therapy-naïve patients lost-to-care in HIV clinics in Democratic Republic of Congo, Cameroon, and Burundi. AIDS Care 2016; 28:913-8. [PMID: 26855169 DOI: 10.1080/09540121.2015.1124982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Antiretroviral therapy (ART)-naïve patients are vulnerable to becoming lost-to-care (LTC) because they are not monitored as often as patients on treatment. We examined data from 19,461 HIV positive adults at 10 HIV clinics in Democratic Republic of Congo (DRC), Cameroon, and Burundi participating in the Phase 1 International epidemiologic Databases to Evaluate AIDS Central Africa (IeDEA-CA) study. Patients were LTC if they were ART-naïve and did not return within 7 months of the end of data collection. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) for risk factors associated with LTC. Of 5353 ART-naïve patients, 4420 (83%) were LTC and 933 (17%) were in-care. The odds of being LTC were greatest among patients from DRC (OR = 2.16, CI: 1.64-2.84, p < .0001), males (OR = 1.39, CI: 1.15-1.69, p = .0009), and ages 18-49 (OR = 1.45, CI: 1.16-1.82, p = .001). The odds of being LTC were least among patients with a WHO Clinical Stage of 1 or 2 (OR = 0.65, CI: 0.55-0.77, p < .0001) and in a perceived concordant relationship (OR = 0.61, CI: 0.43-0.87, p < .0001). LTC patients were more likely to have characteristics associated with higher risk for HIV transmission and progression. Many entered care at advanced stages and were less likely to know their partner's serostatus. Greater efforts to retain ART-naïve patients may increase earlier initiation of ART.
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Affiliation(s)
| | | | - Modeste Kiumbu
- b Kinshasa School of Public Health (KSPH) , Hôpital Général de Kinshasa , Kinshasa-Gombe , Democratic Republic of Congo
| | - Joseph Atibu
- b Kinshasa School of Public Health (KSPH) , Hôpital Général de Kinshasa , Kinshasa-Gombe , Democratic Republic of Congo
| | | | | | | | | | - Henri Mukumbi
- g ACS/AMO Congo , Kinshasa , Democratic Republic of Congo
| | | | | | - Jamie Newman
- a RTI International , Research Triangle Park , NC , USA
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Goodrich S, Ndege S, Kimaiyo S, Some H, Wachira J, Braitstein P, Sidle JE, Sitienei J, Owino R, Chesoli C, Gichunge C, Komen F, Ojwang C, Sang E, Siika A, Wools-Kaloustian K. Delivery of HIV care during the 2007 post-election crisis in Kenya: a case study analyzing the response of the Academic Model Providing Access to Healthcare (AMPATH) program. Confl Health 2013; 7:25. [PMID: 24289095 PMCID: PMC4176498 DOI: 10.1186/1752-1505-7-25] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 11/20/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Widespread violence followed the 2007 presidential elections in Kenya resulting in the deaths of a reported 1,133 people and the displacement of approximately 660,000 others. At the time of the crisis the United States Agency for International Development-Academic Model Providing Access to Healthcare (USAID-AMPATH) Partnership was operating 17 primary HIV clinics in western Kenya and treating 59,437 HIV positive patients (23,437 on antiretroviral therapy (ART)). METHODS This case study examines AMPATH's provision of care and maintenance of patients on ART throughout the period of disruption. This was accomplished by implementing immediate interventions including rapid information dissemination through the media, emergency hotlines and community liaisons; organization of a Crisis Response leadership team; the prompt assembly of multidisciplinary teams to address patient care, including psychological support staff (in clinics and in camps for internally displaced persons (IDP)); and the use of the AMPATH Medical Records System to identify patients on ART who had missed clinic appointments. RESULTS These interventions resulted in the opening of all AMPATH clinics within five days of their scheduled post-holiday opening dates, 23,949 patient visits in January 2008 (23,259 previously scheduled), uninterrupted availability of antiretrovirals at all clinics, treatment of 1,420 HIV patients in IDP camps, distribution of basic provisions, mobilization of outreach services to locate missing AMPATH patients and delivery of psychosocial support to 300 staff members and 632 patients in IDP camps. CONCLUSION Key lessons learned in maintaining the delivery of HIV care in a crisis situation include the importance of advance planning to develop programs that can function during a crisis, an emphasis on a rapid programmatic response, the ability of clinics to function autonomously, patient knowledge of their disease, the use of community and patient networks, addressing staff needs and developing effective patient tracking systems.
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Affiliation(s)
- Suzanne Goodrich
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Samson Ndege
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Epidemiology, School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Sylvester Kimaiyo
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Hosea Some
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Juddy Wachira
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Paula Braitstein
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
- Divison of Global Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - John E Sidle
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Regenstrief Institute, Indianapolis, USA
| | - Jackline Sitienei
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Health Policy and Management, School of Public Health, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Regina Owino
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Cleophas Chesoli
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Catherine Gichunge
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- School of Public Health, Griffith Health Institute, Griffith University, Southport, Queensland, Australia
| | - Fanice Komen
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Claris Ojwang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Edwin Sang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Abraham Siika
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Kara Wools-Kaloustian
- Department of Medicine, Indiana University School of Medicine, Indianapolis, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
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