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Okere NE, Censi V, Machibya C, Costigan K, Katambi P, Martelli G, de Klerk J, Hermans S, Gomez GB, Pozniak A, de Wit TR, Naniche D. Beyond viral suppression: Quality of life among stable ART clients in a differentiated service delivery intervention in Tanzania. Qual Life Res 2021; 31:159-170. [PMID: 34052956 PMCID: PMC8800900 DOI: 10.1007/s11136-021-02889-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND With antiretroviral therapy, more people living with HIV (PLHIV) in resource-limited settings are virally suppressed and living longer. WHO recommends differentiated service delivery (DSD) as an alternative, less resource-demanding way of expanding HIV services access. Monitoring client's health-related quality of life (HRQoL) is necessary to understand patients' perceptions of treatment and services but is understudied in sub-Saharan Africa. We assessed HRQoL among ART clients in Tanzania accessing two service models. METHODS Cross-sectional survey from May-August 2019 among stable ART clients randomly sampled from clinics and clubs in the Shinyanga region providing DSD and clinic-based care. HRQoL data were collected using a validated HIV-specific instrument-Functional Assessment of HIV infection (FAHI), in addition to socio-demographic, HIV care, and service accessibility data. Descriptive analysis of HRQoL, logistic regression and a stepwise multiple linear regression were performed to examine HRQoL determinants. RESULTS 629 participants were enrolled, of which 40% accessed DSD. Similar HRQoL scores [mean (SD), p-value]; FAHI total [152.2 (22.2) vs 153.8 (20.6), p 0.687] were observed among DSD and clinic-based care participants. Accessibility factors contributed more to emotional wellbeing among DSD participants compared to the clinic-based care participants (53.4% vs 18.5%, p = < 0.001). Satisfactory (> 80% of maximum score) HRQoL scoring was associated with (OR [95% CI], p-value) being male (2.59 [1.36-4.92], p 0.004) among clinic participants and with urban residence (4.72 [1.70-13.1], p 0.001) among DSD participants. CONCLUSIONS Similar HRQoL was observed in DSD and clinic-based care. Our research highlights focus areas to identify supporting interventions, ultimately optimizing HRQoL among PLHIV.
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Affiliation(s)
- Nwanneka Ebelechukwu Okere
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
| | - Veronica Censi
- Doctors with Africa (CUAMM), Test & Treat Project Shinyanga, Shinyanga, Tanzania
| | | | - Kathleen Costigan
- Bugisi Health Centre, Catholic Diocese of Shinyanga, Shinyanga, Tanzania
| | - P Katambi
- Ngokolo Health Centre, Catholic Diocese of Shinyanga, Shinyanga, Tanzania
| | - Giulia Martelli
- Doctors with Africa (CUAMM), Test & Treat Project Shinyanga, Shinyanga, Tanzania
| | - Josien de Klerk
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Sabine Hermans
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Gabriela B Gomez
- Department of Global Health and Development London School of Health and Tropical Medicine United Kingdom, London, UK
| | - Anton Pozniak
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Tobias Rinke de Wit
- Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Denise Naniche
- Barcelona Institute for Global Health, University of Barcelona, Barcelona, Spain
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Kamacooko O, Mayanja Y, Bagiire D, Namale G, Hansen CH, Seeley J. Predictors of lost to follow-up in a "test and treat" programme among adult women with high-risk sexual behavior in Kampala, Uganda. BMC Public Health 2020; 20:353. [PMID: 32183759 PMCID: PMC7079529 DOI: 10.1186/s12889-020-8439-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/02/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Immediate uptake of antiretroviral therapy (ART) after an HIV-positive diagnosis (Test and Treat) is now being implemented in Uganda. Data are limited on lost to follow-up (LTFU) in high-risk cohorts that have initiated 'Test and Treat'. We describe LTFU in a cohort of women of high-risk sexual behaviour who initiated ART under "Test and Treat". METHODS We performed a retrospective cohort study of participant records at the Good Health for Women Project (GHWP) clinic, a clinic in Kampala for women at high-risk of HIV-infection. We included HIV positive women ≥18 years who initiated ART at GHWP between August 2014 and March 2018. We defined LTFU as not taking an ART refill for ≥3 months from the last clinic appointment among those not registered as dead or transferred to another clinic. We used the Kaplan-Meier technique to estimate time to LTFU after ART initiation. Predictors of LTFU were assessed using a multivariable Cox proportional hazards model. RESULTS The mean (±SD) age of the 293 study participants was 30.3 (± 6.5) years, with 274 (94%) reporting paid sex while 38 (13%) had never tested for HIV before enrolment into GHWP. LTFU within the first year of ART initiation was 16% and the incidence of LTFU was estimated at 12.7 per 100 person-years (95%CI 9.90-16.3). In multivariable analysis, participants who reported sex work as their main job at ART initiation (Adjusted Hazards Ratio [aHR] =1.95, 95%CI 1.10-3.45), having baseline WHO clinical stage III or IV (aHR = 2.75, 95% CI 1.30-5.79) were more likely to be LTFU. CONCLUSION LTFU in this cohort is high. Follow up strategies are required to support women on Test and Treat to remain on treatment, especially those who engage in sex work and those who initiate ART at a later stage of disease.
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Affiliation(s)
- Onesmus Kamacooko
- MRC/UVRI & LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, P. O Box 49, Entebbe, Uganda.
| | - Yunia Mayanja
- MRC/UVRI & LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, P. O Box 49, Entebbe, Uganda
| | - Daniel Bagiire
- MRC/UVRI & LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, P. O Box 49, Entebbe, Uganda
| | - Gertrude Namale
- MRC/UVRI & LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, P. O Box 49, Entebbe, Uganda
| | - Christian Holm Hansen
- MRC/UVRI & LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, P. O Box 49, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Janet Seeley
- MRC/UVRI & LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, P. O Box 49, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Assemie MA, Muchie KF, Ayele TA. Incidence and predictors of loss to follow up among HIV-infected adults at Pawi General Hospital, northwest Ethiopia: competing risk regression model. BMC Res Notes 2018; 11:287. [PMID: 29747698 PMCID: PMC5946498 DOI: 10.1186/s13104-018-3407-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 05/07/2018] [Indexed: 01/05/2023] Open
Abstract
Objective This study was aimed at assessing the incidence of lost-to-follow-up and its predictors among HIV-positive adults after initiation into antiretroviral therapy at Pawi General Hospital, northwest Ethiopia. Results The overall cumulative incidence of lost-to-follow-up after ART initiation was high, 11.6 (95% CI 9.8–13.7) per 100 adult-years follow-up time. Independent significant predictors of lost to follow up were being aged 15–28 years (aSHR = 0.44; 95% CI 0.24–0.83), being on WHO clinical stage IV (aSHR = 2.09; 95% CI 1.02–3.13); and receiving isoniazid preventive therapy (aSHR = 0.11; 95% CI 0.06–0.18). Electronic supplementary material The online version of this article (10.1186/s13104-018-3407-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Moges Agazhe Assemie
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Kindie Fentahun Muchie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Breger TL, Newman JE, Mfangam Molu B, Akam W, Balimba A, Atibu J, Kiumbu M, Azinyue I, Hemingway-Foday J, Pence BW. Self-disclosure of HIV status, disclosure counseling, and retention in HIV care in Cameroon. AIDS Care 2016; 29:838-845. [PMID: 28024412 DOI: 10.1080/09540121.2016.1271390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Poor retention in care is common among HIV-positive adults in sub-Saharan Africa settings and remains a key barrier to HIV management. We quantify the associations of disclosure of HIV status and referral to disclosure counseling with successful retention in care using data from three Cameroon clinics participating in the Phase 1 International epidemiologic Databases to Evaluate AIDS Central Africa cohort. Of 1646 patients newly initiating antiretroviral therapy between January 2008 and January 2011, 43% were retained in care following treatment initiation. Self-disclosure of HIV status to at least one person prior to treatment initiation was associated with a minimal increase in the likelihood of being retained in care (risk ratio [RR] = 1.14; 95% confidence interval (CI): 0.94, 1.38). However, referral to disclosure counseling was associated with a moderate increase in retention (RR = 1.37; 95% CI: 1.21, 1.55) and was not significantly modified by prior disclosure status (p = .3). Our results suggest that while self-disclosure may not significantly improve retention among patients receiving care at these Cameroon sites, counseling services may play an important role regardless of prior disclosure status.
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Affiliation(s)
- Tiffany L Breger
- a Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | | | | | | | | | - Joseph Atibu
- f Ecole de Santé Publique , Kinshasa , Democratic Republic of the Congo
| | - Modeste Kiumbu
- f Ecole de Santé Publique , Kinshasa , Democratic Republic of the Congo
| | | | | | - Brian W Pence
- a Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
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Mberi MN, Kuonza LR, Dube NM, Nattey C, Manda S, Summers R. Determinants of loss to follow-up in patients on antiretroviral treatment, South Africa, 2004-2012: a cohort study. BMC Health Serv Res 2015; 15:259. [PMID: 26141729 PMCID: PMC4491264 DOI: 10.1186/s12913-015-0912-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 06/08/2015] [Indexed: 11/16/2022] Open
Abstract
Background The number of Human Immunodeficiency Virus (HIV) infected people eligible for initiation on antiretroviral Therapy (ART) is increasing. ART programmatic success requires that patients who are taking ART remain on treatment and are followed up regularly. This study investigated factors associated with being lost to follow-up, in a cohort of patients enrolled in a pharmacovigilance study in South Africa. Methods This was a retrospective observational cohort study performed at one of the Medunsa National Pharmacovigilance Centre’s (MNPC) ART sentinel surveillance sites. Loss to Follow-up (LTFU) was defined as “a patient who had been followed up at the sentinel site, who had not had contact with the health facility for 180 days or more since their last recorded expected date of return or if there were 180 days or more between the expected date of return and the next clinic visit”. Results Out of 595 patients, 65.5 % (n = 390) were female and 23.4 % (n = 139) were LTFU. The median time on ART before LTFU was 21.5 months (interquartile range: 12.9 – 34.7 months). The incidence rate of LTFU was 103 per 1000 person-years in the first year on ART and increased to 405 per 1000 person-years in the eighth year of taking ART. Factors associated with becoming LTFU included not having a committed partner (Adjusted Hazard Ratio (aHR): 2.9, 95 % Confidence Interval (CI):1.19-6.97, p = 0.019), being self-employed (aHR: 13.9, 95 % CI:2.81 - 69.06, p = 0.001), baseline CD4 count > 200 cells/ml (aHR: 3.8, 95 % CI: 1.85-7.85, p < 0.001), detectable last known Viral Load (VL) (aHR: 3.6, 95 % CI:1.98 - 6.52, p < 0.001) and a last known World Health Organisation clinical stage three or four (aHR: 2.0, 95 % CI:1.22-3.27, p = 0.006). Patients that previously had an ART adverse event had a lower risk (aHR: 0.6, 95 % CI: 0.38 - 0.99, p = 0.044) of becoming LTFU than those that had not. Conclusion The incidence rate of LTFU increases with additional years on ART. Intensified measures to improve patient retention on ART must be prioritised with increasing patient time on ART and in patients that are at increased risk of becoming lost to follow-up.
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Affiliation(s)
- Mazvita Naome Mberi
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases of the National Health Laboratory Services, 1 Modderfontein Road, Monument Park 0105, Post net suite 179, P/bag X27923, Sandringham, South Africa. .,School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, Dr Savage Road 0084 Pinshof 349, Pretoria, South Africa. .,Medunsa National Pharmacovigilance Centre, Medunsa Campus, University of Limpopo, Pretoria, South Africa. .,Wits Reproductive Health and HIV Institute, 22 Esselen Street, Hillbrow, South Africa.
| | - Lazarus Rugare Kuonza
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases of the National Health Laboratory Services, 1 Modderfontein Road, Monument Park 0105, Post net suite 179, P/bag X27923, Sandringham, South Africa. .,School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, Dr Savage Road 0084 Pinshof 349, Pretoria, South Africa.
| | - Nomathemba Michelle Dube
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases of the National Health Laboratory Services, 1 Modderfontein Road, Monument Park 0105, Post net suite 179, P/bag X27923, Sandringham, South Africa.
| | - Cornelius Nattey
- National Institute for Occupational Health, Smit Street, Braamfontein, South Africa. .,Global Partnership Initiated Academia for the control of health threats, Bernard Nocht Institute for Tropical Medicine, Bernad-Nocht Street 74, 20259, Hamburg, Germany.
| | - Samuel Manda
- Biostatistics Research unit, South African Medical Research Council, 1 Soutpansberg Road, Pretoria, South Africa. .,Division of Epidemiology and biostatistics, School of Public Health, University of the Witwatersrand, 27 St Andrews Road Parktown, Johannesburg, South Africa.
| | - Robert Summers
- Medunsa National Pharmacovigilance Centre, Medunsa Campus, University of Limpopo, Pretoria, South Africa. .,Department of Pharmacy, Faculty of Health Sciences, MEDUNSA Campus, University of Limpopo, Pretoria, South Africa.
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Rubaihayo J, Tumwesigye NM, Konde-Lule J. Trends in prevalence of selected opportunistic infections associated with HIV/AIDS in Uganda. BMC Infect Dis 2015; 15:187. [PMID: 25879621 PMCID: PMC4408591 DOI: 10.1186/s12879-015-0927-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/08/2015] [Indexed: 11/12/2022] Open
Abstract
Background After more than a decade of establishing and expanding access to highly active antiretroviral therapy (HAART), empirical evidence on its impact on trends of opportunistic infections (OIs) associated with the deadly human immunodeficiency virus (HIV) in resource poor settings is scarce. The primary objective of this study was to assess the effect of HAART coverage on trends of five most common OIs in Uganda. Methods Observational data from January 2002 to December 2013 for 5972 HIV positive individuals attending the AIDS Support Organisation (TASO) HIV/AIDS care programme in Uganda were extracted and analysed. Trends were analysed using autoregressive moving average time series and mixed effects linear regression models adjusting for all available potential confounders. Results A total of 204,871 monthly medical reports were retrieved and analysed. Majority of the participants were female (73%) with a median age of 32 years (inter-quartile range 26–39). Overall, significant decreasing mean annual prevalence trends were observed for Mycobacterium tuberculosis, herpes zoster, genital ulcer and oral candidiasis (p < 0.05, X2trend). Non-significant declining mean annual prevalence trend was observed for cryptococcal meningitis (p = 0.181, X2trend). The largest impact of HAART was observed in Oral candidiasis and TB whose average annual prevalence reduced by 61% and 43% respectively following the introduction of HAART. Monthly series for TB, Herpes zoster and genital ulcers differed significantly by age and clinic but only genital ulcer series differed significantly by sex (p < 0.05, kruskal wallis). After controlling for the effects of age, sex and clinic (fixed) and monthly clustering (random effect) in a mixed effects linear regression model, all the five OIs showed a significant monthly change in prevalence (p < 0.001). Conclusion Overall, prevalence of most OIs declined especially after the introduction of HAART. However significant variations exist in the trends of different OIs in different geographical areas in Uganda. It is therefore important that site specific factors are properly identified to enable the development of targeted interventions.
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Affiliation(s)
- John Rubaihayo
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda. .,Department of Public Health, School of Health Sciences, Mountains of the Moon University, Fort Portal, Uganda.
| | - Nazarius M Tumwesigye
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Joseph Konde-Lule
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
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