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Birhanu MY, Bekele GM, Yirdaw G, Demissie BS, Getahun GK, Jemberie SS. Incidence and predictors of loss to follow-up among Ethiopian children on antiretroviral therapy: a systematic review and meta-analysis. BMC Public Health 2024; 24:169. [PMID: 38218779 PMCID: PMC10787475 DOI: 10.1186/s12889-023-17333-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 11/25/2023] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION Loss of follow-up (LTFU) from ART regular follow-up is one of the key acknowledged causes for the development of ART-resistant virus strains currently. It becomes a major weakness for the successful implementation of HIV care and treatment programs mainly in Sub-Saharan Africa but also globally. About 20-40% of children on ART loss their regular ART follow-up annually. Because of the inconsistency of the prior publications' findings, policymakers, programmers, and healthcare providers find it difficult to intervene. Hence, this study was conducted to provide a pooled incidence and identify the predictors of LTFU among children on ART in Ethiopia. METHODS Articles were searched from PubMed/ MEDLINE, CINAHL, EMBASE, Google Scholar, and Science Direct, as well as organizational records and websites. This review included both retrospective and prospective follow-up studies published in English. The data were extracted using Microsoft Excel and exported into Stata™ Version 17.0 for further processing and analysis. The presence of heterogeneity was assessed using forest plots with the I2 test. To identify the source of heterogeneity subgroup analysis, meta-regression, publication bias, and sensitivity analysis were computed. The pooled incidence of LTFU was estimated using a random effects meta-analysis model with the DerSimonian-laired method. To identify the predictors, a 95% confidence interval with relative risk was used to declare the presence or absence of an association. RESULTS In this systematic review and Meta-analysis, nine studies with a total of 3336 children were included. The pooled incidence of LTFU from ART was 5.83 (95% CI: 3.94, 7.72) per 100 children-years of observation with I2: 83% & p-value < 0.001. Those children who were from rural were had a 1.65 (95% CI: 1.06, 2.52) times higher chance of getting LTFU when compared with their counterparts. Children who had poor ART adherence had a 2.03 (95% CI: 1.23, 3.34) times higher chance of experiencing LTFU of ART than children having good ART adherence. CONCLUSIONS Among Ethiopian children on ART, one out of 167 had the risk of experiencing LTFU. Being rural dwellers and having poor ART adherence were the identified predictors of LTFU. Close follow-up and phone message text should be used to have good ART adherence among rural dwellers to meet the predetermined goal of ART.
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Affiliation(s)
- Molla Yigzaw Birhanu
- Department of Public Health, College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia.
| | - Getamesay Molla Bekele
- Department of Gynecology and Obstetric, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Getasew Yirdaw
- Department of Environmental Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
| | - Bekele Simegn Demissie
- Department of Public Health, St.Lideta College of Health Science and Business, Addis Ababa, Ethiopia
| | - Genanew Kassie Getahun
- Department of Public Health, Menelik II Medical and Health Science College, Addis Ababa, Ethiopia
| | - Selamawit Shita Jemberie
- Department of Midwifery, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
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Ramwell C, Liomba AM, Takle M, Barber JR, Manda-Taylor L, Pleau C, Postels DG. Loss to Hospital Follow-Up in Pediatric Cerebral Malaria Survivors: A Case-Control Study. Am J Trop Med Hyg 2023; 109:1077-1080. [PMID: 37748770 PMCID: PMC10622480 DOI: 10.4269/ajtmh.23-0403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 07/12/2023] [Indexed: 09/27/2023] Open
Abstract
Children surviving central nervous system (CNS) infections are at high risk of neurological, behavioral, and cognitive sequalae. Early identification, characterization, and treatment of these sequelae may improve child and family health. In Africa, it is unclear if there are demographic or clinical factors that increase the risk of post-hospital loss to follow-up in children with CNS infections. If these factors exist, targeted educational efforts to increase rates of post-hospital retention could be focused on families at highest risk. We performed a case-control study of Malawian children with cerebral malaria, a locally common CNS infection, previously admitted to a specialized research unit in Blantyre, Malawi. Routine survivor post-hospital follow-up was scheduled for 1 month, 6 months, and 12 months. We compared demographic and clinical characteristics between 84 children who missed one or more of these post-hospital visits with 120 children who attended all visits. There were no statistically significant differences in demographic or clinical characteristics between children whose families returned for all follow-up visits and those who did not. Specifically, when comparing these groups, we found no differences in age (P = 00.646), sex (P = 0.789), duration of hospitalization (P = 0.903), distance from home to hospital (P = 0.355), type or severity of neurological sequelae (P = 0.837), guardian literacy (P = 0.057), or number of discharge medications (P = 0.464). No factors assessed in this study were associated with higher risk of loss to follow-up in Malawian child survivors of CNS infections. During hospitalization, educational efforts to increase post-hospital retention should focus on all families.
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Affiliation(s)
- Carolyn Ramwell
- Division of Cardiology, Children’s National Hospital, Washington, District of Columbia
| | | | - Mrinmayee Takle
- Division of Neurology, Children’s National Hospital, Washington, District of Columbia
| | - John R. Barber
- Division of Biostatistics and Study Methodology, Children’s National Research Institute, Washington, District of Columbia
| | - Lucinda Manda-Taylor
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Cara Pleau
- Division of Cardiology, Children’s National Hospital, Washington, District of Columbia
| | - Douglas G. Postels
- Blantyre Malaria Project, Blantyre, Malawi
- Division of Neurology, Children’s National Hospital, Washington, District of Columbia
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Nsoh M, Tshimwanga KE, Ngum BA, Mgasa A, Otieno MO, Moali B, Sirili N, Atanga NS, Halle-Ekane GE. Predictors of antiretroviral therapy interruptions and factors influencing return to care at the Nkolndongo Health District, Cameroon. Afr Health Sci 2021; 21:29-38. [PMID: 34447421 PMCID: PMC8367305 DOI: 10.4314/ahs.v21i1.6s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Antiretroviral therapy is a lifelong commitment that requires consistent intake of tablets to optimize health outcomes, attain and maintain viral suppression. OBJECTIVE We aimed to elicit predictors of treatment interruption amongst PLHIV and identify motivating factors influencing return to care. METHOD We conducted a cross-sectional study using a mixed-method approach in four hospitals in Yaoundé. Sociodemographic and clinical data were collected from ART registers. Using purposeful sampling, thirteen participants were enrolled for interviews. Quantitative data were analyzed using Epi-Info and Atlas-TI for qualitative analysis. Ethical clearance approved by CBCHS-IRB. RESULTS A total of 271 participants records were assessed. The mean age was 33 years (SD±11years). Private facilities CASS and CMNB registered respectively 53 (19.6%) and 14 (5.2%) participants while CMA Nkomo and IPC had 114 (42.1%) and 90 (33.2%) participants. Most participants (75.3%) were females [OR 1.14; CI 0.78-1.66] compare with males. 78% had no viral load test results. Transport cost and stigmatization constituted the most prominent predictors of treatment interruption (47.5%) and (10.5%) respectively. Belief in the discovery of an eminent HIV cure and the desire to raise offspring motivated 30% and 61%, respectively to resume treatment. CONCLUSION Structural barriers like exposed health facility, and dispensing ARVs in open spaces stigmatizes clients and increases odds of attrition. Attrition of patients on ART will be minimized through implementation of client centered approaches like multiplying proxy ART pick points, devolving stable clients to community ARV model.
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Affiliation(s)
- Marius Nsoh
- Department of Public Health, School of Health Sciences, Catholic University of Central Africa; Cameroon
- HIV Free Project, Cameroon Baptist Convention Health Services, Center region; Cameroon
| | - Katayi E Tshimwanga
- HIV Free Project, Cameroon Baptist Convention Health Services, Center region; Cameroon
| | - Busi A Ngum
- Women Health Program, Mbingo Baptist Hospital, Cameroon Baptist Convention Health Services; Cameroon
| | - Avelina Mgasa
- Ministry of Health Community Development, Gender, Elderly and Children; National Blood Transfusion Service; Tanzania
| | - Moses O Otieno
- National AIDS and Sexually Transmitted Infections Control Program (NASCOP); Kenya
| | - Bokwena Moali
- Ministry of Health and Wellness, Okavango District, Botswana
| | - Nathanael Sirili
- Department of Development Studies, Muhimbili University of Health and Allied Sciences; Tanzania
| | - Ndeso S Atanga
- Department of Public Health, Obstetrics and Gynecology, Faculty of Health Sciences, University of Buea; Cameroon
| | - Gregory E Halle-Ekane
- Department of Public Health, Obstetrics and Gynecology, Faculty of Health Sciences, University of Buea; Cameroon
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Assemie MA, Leshargie CT, Petrucka P. Outcomes and factors affecting mortality and successful tracing among patients lost to follow-up from antiretroviral therapy in Pawi Hospital, Northwest Ethiopia. Trop Med Health 2019; 47:52. [PMID: 31719791 PMCID: PMC6836319 DOI: 10.1186/s41182-019-0181-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/26/2019] [Indexed: 11/10/2022] Open
Abstract
Background Loss to follow-up (LTFU) is a major public health problem to antiretroviral therapy (ART) programs in sub-Saharan Africa. Failure to account for patients' LTFU outcomes (self-transfers and restarts) can result in inaccurate reporting of retention in care. In Ethiopia, specifically in the Benishangule Gumuz region, high LTFU reported patients, who were not assessed for their outcomes, are identified as a gap. Therefore, our objective was to determine the outcomes (alive or dead) of patients lost to follow-up (LTFU) from ART and identify factors associated with successful tracing and mortality of these patients. Results The proportion of successful tracing was 75.5% (249 of 330). Among the traced patients (n = 249), 22.9% were deceased, 47.8% were on ART, and 29.3% had discontinued treatment. However, the remaining untraceable patients were not locatable due to wrong addresses (53.1%), change of residence (29.6%), and/or lack of functional phone contact (17.3%). Some (32.9%) of the patients discontinued because of negative test results, others (21.9%) for spiritual reasons or side effects (28.8%), and the remaining (16.4%) for other reasons. Tracing using phone numbers (AOR = 2.97, 95% CI 1.57-5.59) and existing long-term follow-up period for ART (AOR = 2.13, 95% CI 1.17-3.88) were strong predictors of successful tracing while not receiving cotrimoxazole preventive therapy (CPT) (AOR = 2.59, 95% CI 1.22-5.39) is a predictor for mortality of patients post-LTFU. Conclusion ART programs need to retain current contact information of patients or guardians/friends for tracing. Having phone contact numbers and prolonged lengths of compliance with ART are predictors of successful tracing, while lack of cotrimoxazole preventive therapy is a predictor of mortality. Early tracing of beginners (newly admitted recipients) and updating their detailed information at each follow-up visit is essential.
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Affiliation(s)
- Moges Agazhe Assemie
- 1Department of Public Health, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Cheru Tesema Leshargie
- 2Department of Environmental Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Pammla Petrucka
- 3College of Nursing, University of Saskatchewan, Saskatoon, Canada.,4School of Life Sciences and Bioengineering, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
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Webb S, Hartland J. A retrospective notes-based review of patients lost to follow-up from anti-retroviral therapy at Mulanje Mission Hospital, Malawi. Malawi Med J 2019; 30:73-78. [PMID: 30627332 PMCID: PMC6307064 DOI: 10.4314/mmj.v30i2.4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim To analyse patients with HIV who were lost to follow-up from anti-retroviral therapy (ART) at Mulanje Mission Hospital (MMH), Malawi. Methods All patients on adult antiretroviral combinations at MMH, who were classified as lost to follow-up (LTFU) according to the national guidelines (patients missing a scheduled follow-up visit by more than two months) over a 12-month period, were included in the study and compared against a control group who had never been lost. Variables compared were gender, age, months on ART, time of year, WHO clinical stage, ART regimen, reported side effects, number of doses missed in the previous 12 months, whether the patient has been followed up in the community and if so, the length of time elapsed before follow-up. Results In all, 136 patients had been LTFU over the previous 12 months at MMH. Of these, 43 had incomplete or missing ART cards, resulting in 93 LTFU patient's data that could be analysed. Patients were more likely to get LTFU if they were men (p=0.03), who had been on anti-retroviral therapy for a short duration (p=0.06) and the proportion of patients who missed more than 4 doses in the previous 12 months was higher among LTFU patients (p=0.05). Only 34.4% of those LTFU had been traced in the community at the time of analysis. Of those traced, 27% had moved to another area, 5.5% had died, 5.5% had the wrong documentation and 62% gave no reason as to why they had missed appointments. Conclusion This study in MMH has highlighted the importance and feasibility of comprehensive facility-level data-collection, both to identify local patient populations at risk of becoming lost to follow-up and to assess the follow-up measures in place to bring these lost to follow-up patients back into the programme. Even in the short time and with the small sample that was collected, there was evidence that patients most likely to get LTFU in MMH were young men, who had been on anti-retroviral therapy for a short duration and had missed over 4 doses in the last 12 months.
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Affiliation(s)
- Silas Webb
- Croydon University Hospital and University of Bristol
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Leyns CC, De Maeseneer J, Willems S. Using concept mapping to identify policy options and interventions towards people-centred health care services: a multi stakeholders perspective. Int J Equity Health 2018; 17:177. [PMID: 30514317 PMCID: PMC6278128 DOI: 10.1186/s12939-018-0895-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 11/20/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND People-centred health care (PCC) services are identified by the WHO as important building blocks towards universal health coverage. In 2016 the WHO formulated a comprehensive framework on integrated PCC services based on an international expert consultation. Yet, expert opinions may fail to recognize the needs of all health system stakeholders. Therefore, a consultation method that includes the health workforce and laypersons, can be instrumental to elaborate this framework more in-depth. This research sought to identify participants' perspectives on policy options and interventions to achieve people-centred health care services from a multi stakeholder perspective. METHODS Study participants, both laypersons and health professionals, were recruited in Belgium. A total of 53 participants engaged in one of the seven concept mapping workshops. In this workshop the concept mapping methodology developed by Trochim, a highly structured qualitative group method for brainstorming and idea sharing, was used to generate and structure participants´ perspectives on what is needed to achieve PCC services. The method was validated using the WHO framework. RESULTS The seven workshops together resulted in 452 different statements that were structured in a framework forming 35 clusters and four overarching domains. The four domains with their most prominent clusters were: (1) governance & policy with intersectoral health policies and affordable health for all; (2) health workforce with excellent communication skills, appreciation of health literacy challenges and respectful attitude based on cultural self-awareness; (3) integrated health services with a greater emphasis on prevention, health promotion and the availability of health education and (4) patient, person and community empowerment and participation with support for informal care, promotion of a healthy lifestyle and contextualised health education. Additionally, this study generated ideas that fitted into every single approach described in the WHO framework. DISCUSSION AND CONCLUSION This study shows that in order to achieve PCC a participative approach involving all stakeholders at all levels is needed. The concept mapping process is one of these approaches that brings together diverse stakeholders and foments their egalitarian and respectful participation. The framework that resulted from this study can inform future debate regarding planning, implementation and monitoring of PCC.
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Affiliation(s)
- Christine Cécile Leyns
- Asociación Interdisciplinaria de Atención Primaria de Salud – Bolivia, Calle Antezana N°686 esquina Salamanca, oficina 1D, Cochabamba, Bolivia
- Department of Public Health and Primary Care, Ghent University, Campus UZ Gent, 6K3, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Jan De Maeseneer
- Department of Public Health and Primary Care, Ghent University, Campus UZ Gent, 6K3, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Campus UZ Gent, 6K3, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
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Singogo E, Keegan TJ, Diggle PJ, van Lettow M, Matengeni A, van Oosterhout JJ, Sodhi S, Joshua M, Taylor BM. Differences in survival among adults with HIV-associated Kaposi's sarcoma during routine HIV treatment initiation in Zomba district, Malawi: a retrospective cohort analysis. Int Health 2017; 9:281-287. [PMID: 28911125 DOI: 10.1093/inthealth/ihx027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 08/21/2017] [Indexed: 11/13/2022] Open
Abstract
Background The HIV epidemic is a major public health concern throughout Africa. Malawi is one of the worst affected countries in sub-Saharan Africa with a 2014 national HIV prevalence currently estimated at 10% (9.3-10.8%) by UNAIDS. Study reports, largely in the African setting comparing outcomes in HIV patients with and without Kaposi's sarcoma (KS) indicate poor prognosis and poor health outcomes amongst HIV+KS patients. Understanding the mortality risk in this patient group could help improve patient management and care. Methods Using data for the 559 adult HIV+KS patients who started ART between 2004 and September 2011 at Zomba clinic in Malawi, we estimated relative hazard ratios for all-cause mortality by controlling for age, sex, TB status, occupation, date of starting treatment and distance to the HIV+KS clinic. Results Patients with tuberculosis (95% CI: 1.05-4.65) and patients who started ART before 2008 (95% CI: 0.34-0.81) were at significantly greater risk of dying. A random-effects Cox model with Log-Gaussian frailties adequately described the variation in the hazard for mortality. Conclusion The year of starting ART and TB status significantly affected survival among HIV+KS patients. A sub-population analysis of this kind can inform an efficient triage system for managing vulnerable patients.
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Affiliation(s)
- Emmanuel Singogo
- Lancaster Medical School, Lancaster University, LA1 4YF, Lancashire, UK
| | - Thomas J Keegan
- Lancaster Medical School, Lancaster University, LA1 4YF, Lancashire, UK
| | - Peter J Diggle
- Lancaster Medical School, Lancaster University, LA1 4YF, Lancashire, UK
| | - Monique van Lettow
- Dignitas International, Zomba, Malawi.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Joep J van Oosterhout
- Dignitas International, Zomba, Malawi.,Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | | | - Benjamin M Taylor
- Lancaster Medical School, Lancaster University, LA1 4YF, Lancashire, UK
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Loss to Follow-up Trends in HIV-Positive Patients Receiving Antiretroviral Treatment in Asia From 2003 to 2013. J Acquir Immune Defic Syndr 2017; 74:555-562. [PMID: 28129256 DOI: 10.1097/qai.0000000000001293] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Over time, there has been a substantial improvement in antiretroviral treatment (ART) programs, including expansion of services and increased patient engagement. We describe time trends in, and factors associated with, loss to follow-up (LTFU) in HIV-positive patients receiving ART in Asia. METHODS Analysis included HIV-positive adults initiating ART in 2003-2013 at 7 ART programs in Asia. Patients LTFU had not attended the clinic for ≥180 days, had not died, or transferred to another clinic. Patients were censored at recent clinic visit, follow-up to January 2014. We used cumulative incidence to compare LTFU and mortality between years of ART initiation. Factors associated with LTFU were evaluated using a competing risks regression model, adjusted for clinical site. RESULTS A total of 8305 patients were included. There were 743 patients LTFU and 352 deaths over 26,217 person-years (pys), a crude LTFU, and mortality rate of 2.83 (2.64-3.05) per 100 pys and 1.34 (1.21-1.49) per 100 pys, respectively. At 24 months, the cumulative LTFU incidence increased from 4.3% (2.9%-6.1%) in 2003-05 to 8.1% (7.1%-9.2%) in 2006-09 and then decreased to 6.7% (5.9%-7.5%) in 2010-13. Concurrently, the cumulative mortality incidence decreased from 6.2% (4.5%-8.2%) in 2003-05 to 3.3% (2.8%-3.9%) in 2010-13. The risk of LTFU reduced in 2010-13 compared with 2006-09 (adjusted subhazard ratio = 0.73, 0.69-0.99). CONCLUSIONS LTFU rates in HIV-positive patients receiving ART in our clinical sites have varied by the year of ART initiation, with rates declining in recent years whereas mortality rates have remained stable. Further increases in site-level resources are likely to contribute to additional reductions in LTFU for patients initiating in subsequent years.
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Ndubuka NO, Lim HJ, van der Wal DM, Ehlers VJ. Health-related quality of life of antiretroviral treatment defaulters in Botswana. South Afr J HIV Med 2016; 17:475. [PMID: 29568617 PMCID: PMC5843183 DOI: 10.4102/sajhivmed.v17i1.475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 09/05/2016] [Indexed: 12/04/2022] Open
Abstract
Background Antiretroviral therapy (ART) improves patients’ health-related quality of life (HRQoL). Defaulting from ART has detrimental consequences, including the development of viral resistance, treatment failure and increased risks of disease progression. Little is known about the quality of life of ART defaulters and reasons for discontinuing their ART. Objectives This study sought to measure the HRQoL of ART patients in Botswana who were on ART for up to 5 years but had discontinued treatment for at least 3 months, and to identify factors associated with ART defaulting. Method We conducted a cross-sectional study with 104 eligible respondents in four ART clinics in south eastern Botswana. We assessed respondents’ HRQoL using the World Health Organization Quality of Life Questionnaire for HIV short form. Clinical information was obtained from respondents’ medical records. Data were analysed using SAS version 9.2. Results Reasons for discontinuing ART were inaccessible clinics (22.4%), feeling better (21.4%), running out of pills (11.2%), depression (8.2%), lack of care and/or support (8.2%), failure to understand instructions (7.7%), medications’ side effects (6.1%) and alcohol abuse (3.1%). In multivariate analyses, respondents aged 36–45 years had a 0.03 lower independence HRQoL score compared to those aged 35 and younger (β = -0.03; 95% confidence interval: -1.72, -1.66). Despite defaulting from their ART, respondents’ calculated HRQoL scores were moderate. Conclusion This study highlights the need to enhance ART adherence in order to improve the HRQoL of people living with HIV and/or AIDS.
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Affiliation(s)
- Nnamdi O Ndubuka
- Department of Health Studies, University of South Africa, South Africa.,Northern Inter-Tribal Health Authority, Prince Albert, South Africa
| | - Hyun J Lim
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Canada
| | | | - Valerie J Ehlers
- Department of Health Studies, University of South Africa, South Africa
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Identifying common barriers and facilitators to linkage and retention in chronic disease care in western Kenya. BMC Public Health 2016; 16:741. [PMID: 27503191 PMCID: PMC4977618 DOI: 10.1186/s12889-016-3462-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 08/05/2016] [Indexed: 11/27/2022] Open
Abstract
Background Sub-Saharan Africa is increasingly being challenged in providing care and treatment for chronic diseases, both communicable and non-communicable. In order to address the challenges of linkage to and retention in chronic disease management, there is the need to understand the factors that can influence engagement in care. We conducted a qualitative study to identify barriers and facilitators to linkage and retention in chronic care for HIV, tuberculosis (TB) and Hypertension (HTN) as part of the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya. Methods In-depth interviews and focus group discussions were conducted July 2012-August 2013. Study participants were purposively sampled from three AMPATH clinics and included patients within the AMPATH program receiving HIV, TB, and HTN care, as well as caregivers of children with HIV, community leaders, and healthcare providers. A set of interview guides were developed to explore perceived barriers and facilitators to chronic disease management, particularly related to linkage to and retention in HIV, TB and HTN care. Data were coded and various themes were identified. We organized the concepts and themes generated using the Andersen-Newman Framework of Health Services Utilization. Results A total of 235 participants including 110 individuals living with HIV (n = 50), TB (n = 39), or HTN (n = 21); 24 caregivers; 10 community leaders; and 62 healthcare providers participated. Barriers and facilitators were categorized as predisposing characteristics, enabling resources and need factors. Many of the facilitators and barriers reported in this study were consistently reported across disease categories including personal drive, patient-provider relationships and the need for social and peer support. Conclusions Our findings provide insight into the individual as well as broader structural factors that can deter or encourage linkage and retention that are relevant across communicable and non-communicable chronic diseases. The findings of the present study suggest that interventions should consider the logistical aspects of accessing care in addition to predisposing and need factors that may affect an individuals’ decision to seek out and remain in appropriate care.
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Rachlis B, Cole DC, van Lettow M, Escobar M. Survival functions for defining a clinical management Lost To Follow-Up (LTFU) cut-off in Antiretroviral Therapy (ART) program in Zomba, Malawi. BMC Med Inform Decis Mak 2016; 16:52. [PMID: 27150958 PMCID: PMC4857410 DOI: 10.1186/s12911-016-0290-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While, lost to follow-up (LTFU) from antiretroviral therapy (ART) can be considered a catch-all category for patients who miss scheduled visits or medication pick-ups, operational definitions and methods for defining LTFU vary making comparisons across programs challenging. Using weekly cut-offs, we sought to determine the probability that an individual would return to clinic given that they had not yet returned in order to identify the LTFU cut-off that could be used to inform clinical management and tracing procedures. METHODS Individuals who initiated ART with Dignitas International supported sites (n = 22) in Zomba, Malawi between January 1 2007-June 30 2010 and were ≥ 1 week late for a follow-up visit were included. Lateness was categorized using weekly cut-offs from ≥1 to ≥26 weeks late. At each weekly cut-off, the proportion of patients who returned for a subsequent follow-up visit were identified. Cumulative Distribution Functions (CDFs) were plotted to determine the probability of returning as a function of lateness. Hazard functions were plotted to demonstrate the proportion of patients who returned each weekly interval relative to those who had yet to return. RESULTS In total, n = 4484 patients with n = 7316 follow-up visits were included. The number of included follow-up visits per patient ranged from 1-10 (median: 1). Both the CDF and hazard function demonstrated that after being ≥9 weeks late, the proportion of new patients who returned relative to those who had yet to return decreased substantially. CONCLUSIONS We identified a LTFU definition useful for clinical management. The simple functions plotted here did not require advanced statistical expertise and were created using Microsoft Excel, making it a particularly practical method for HIV programs in resource-constrained settings.
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Affiliation(s)
- Beth Rachlis
- The Ontario HIV Treatment Network, Toronto, Canada
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Donald C Cole
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Monique van Lettow
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Dignitas International, Zomba, Malawi.
| | - Michael Escobar
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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12
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Toward a Conceptualization of the Content of Psychosocial Screening in Living Organ Donors. Transplantation 2015; 99:2413-21. [DOI: 10.1097/tp.0000000000000771] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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13
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Hernández AR, Hurtig AK, Dahlblom K, San Sebastián M. Integrating views on support for mid-level health worker performance: a concept mapping study with regional health system actors in rural Guatemala. Int J Equity Health 2015; 14:91. [PMID: 26449232 PMCID: PMC4599024 DOI: 10.1186/s12939-015-0225-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/28/2015] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Mid-level health workers are on the front-lines in underserved areas in many LMICs, and their performance is critical for improving the health of vulnerable populations. However, improving performance in low-resource settings is complex and highly dependent on the organizational context of local health systems. This study aims to examine the views of actors from different levels of a regional health system in Guatemala on actions to support the performance of auxiliary nurses, a cadre of mid-level health workers with a prominent role in public sector service delivery. A concept mapping study was carried out to develop an integrated view on organizational support and identify locally relevant strategies for strengthening performance. METHODS A total of 93 regional and district managers, and primary and secondary care health workers participated in generating ideas on actions needed to support auxiliary nurses' performance. Ideas were consolidated into 30 action items, which were structured through sorting and rating exercises, involving a total of 135 of managers and health workers. Maps depicting participants' integrated views on domains of action and dynamics in sub-groups' interests were generated using a sequence of multivariate statistical analyses, and interpreted by regional managers. RESULTS The combined input of health system actors provided a multi-faceted view of actions needed to support performance, which were organized in six domains, including: Communication and coordination, Tools to orient work, Organizational climate of support, Motivation through recognition, Professional development and Skills development. The nature of relationships across hierarchical levels was identified as a cross-cutting theme. Pattern matching and go-zone maps indicated directions for action based on areas of consensus and difference across sub-groups of actors. CONCLUSIONS This study indicates that auxiliary nurses' performance is interconnected with the performance of other health system actors who require support, including managers and community-level collaborators. Organizational climate is critical for making auxiliary nurses feel supported, and greater attention to improving the quality of hierarchical relationships is needed in LMIC settings. The participatory nature of the concept-mapping process enabled health system actors to collaborate in co-production of context-specific knowledge needed to guide efforts to strengthen performance in a vulnerable region.
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Affiliation(s)
- Alison R Hernández
- Division of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.
| | - Anna-Karin Hurtig
- Division of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.
| | - Kjerstin Dahlblom
- Division of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.
| | - Miguel San Sebastián
- Division of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.
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14
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Rachlis B, Ochieng D, Geng E, Rotich E, Ochieng V, Maritim B, Ndege S, Naanyu V, Martin JN, Keter A, Ayuo P, Diero L, Nyambura M, Braitstein P. Implementation and operational research: evaluating outcomes of patients lost to follow-up in a large comprehensive care treatment program in western Kenya. J Acquir Immune Defic Syndr 2015; 68:e46-55. [PMID: 25692336 PMCID: PMC4348019 DOI: 10.1097/qai.0000000000000492] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Academic Model Providing Access To Healthcare (AMPATH) program provides comprehensive HIV care and treatment services. Approximately, 30% of patients have become lost to follow-up (LTFU). We sought to actively trace and identify outcomes for a sample of these patients. METHODS LTFU was defined as missing a scheduled visit by ≥3 months. A randomly selected sample of 17% of patients identified as LTFU between January 2009 and June 2011 was generated, with sample stratification on age, antiretroviral therapy (ART) status at last visit, and facility. Chart reviews were conducted followed by active tracing. Tracing was completed by trained HIV-positive outreach workers July 2011 to February 2012. Outcomes were compared between adults and children and by ART status. RESULTS Of 14,811 LTFU patients, 2540 were randomly selected for tracing (2179 adults, 1071 on ART). The chart reviews indicated that 326 (12.8%) patients were not actually LTFU. Outcomes for 71% of sampled patients were determined including 85% of those physically traced. Of those with known outcomes, 21% had died, whereas 29% had disengaged from care for various reasons. The remaining patients had moved away (n = 458, 25%) or were still receiving HIV care (n = 443 total, 25%). CONCLUSIONS Our findings demonstrate the feasibility of a large-scale sampling-based approach. A significant proportion of patients were found not to be LTFU, and further, high numbers of patients who were LTFU could not be located. Over a quarter of patients disengaged from care for various reasons including access challenges and familial influences.
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Affiliation(s)
- Beth Rachlis
- *Academic Model Providing Access To Healthcare, Eldoret, Kenya; †Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; ‡Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA; §Moi University School of Public Health, Kenya; Departments of ‖Behavioral Sciences; and ¶Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
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15
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Friedman SR, Downing MJ, Smyrnov P, Nikolopoulos G, Schneider JA, Livak B, Magiorkinis G, Slobodianyk L, Vasylyeva TI, Paraskevis D, Psichogiou M, Sypsa V, Malliori MM, Hatzakis A. Socially-integrated transdisciplinary HIV prevention. AIDS Behav 2014; 18:1821-34. [PMID: 24165983 DOI: 10.1007/s10461-013-0643-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Current ideas about HIV prevention include a mixture of primarily biomedical interventions, socio-mechanical interventions such as sterile syringe and condom distribution, and behavioral interventions. This article presents a framework for socially-integrated transdisciplinary HIV prevention that may improve current prevention efforts. It first describes one socially-integrated transdisciplinary intervention project, the Transmission Reduction Intervention Project. We focus on how social aspects of the intervention integrate its component parts across disciplines and processes at different levels of analysis. We then present socially-integrated perspectives about how to improve combination antiretroviral treatment (cART) processes at the population level in order to solve the problems of the treatment cascade and make "treatment as prevention" more effective. Finally, we discuss some remaining problems and issues in such a social transdisciplinary intervention in the hope that other researchers and public health agents will develop additional socially-integrated interventions for HIV and other diseases.
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Affiliation(s)
- Samuel R Friedman
- Institute of Infectious Diseases Research, National Development and Research Institutes, Inc., 71 West 23rd Street, 8th Floor, New York, NY, 10010, USA,
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16
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Tabatabai J, Namakhoma I, Tweya H, Phiri S, Schnitzler P, Neuhann F. Understanding reasons for treatment interruption amongst patients on antiretroviral therapy--a qualitative study at the Lighthouse Clinic, Lilongwe, Malawi. Glob Health Action 2014; 7:24795. [PMID: 25280736 PMCID: PMC4185090 DOI: 10.3402/gha.v7.24795] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/26/2014] [Accepted: 09/04/2014] [Indexed: 11/14/2022] Open
Abstract
Background In recent years, scaling up of antiretroviral therapy (ART) in resource-limited settings moved impressively towards universal access. Along with these achievements, public health HIV programs are facing a number of challenges including the support of patients on lifelong therapy and the prevention of temporary/permanent loss of patients in care. Understanding reasons for treatment interruption (TI) can inform strategies for improving drug adherence and retention in care. Objective To evaluate key characteristics of patients resuming ART after TI at the Lighthouse Clinic in Lilongwe, Malawi, and to identify their reasons for interrupting ART. Design This study uses a mixed methods design to evaluate patients resuming ART after TI. We analysed an assessment form for patients with TI using pre-defined categories and a comments field to identify frequently stated reasons for TI. Additionally, we conducted 26 in-depth interviews to deepen our understanding of common reasons for TI. In-depth interviews also included the patients’ knowledge about ART and presence of social support systems. Qualitative data analysis was based on a thematic framework approach.
Results A total of 347 patients (58.2% female, average age 35.1±11.3 years) with TI were identified. Despite the presence of social support and sufficient knowledge of possible consequences of TI, all patients experienced situations that resulted in TI. Analysis of in-depth interviews led to new and distinct categories for TI. The most common reason for TI was travel (54.5%, n=80/147), which further differentiated into work- or family-related travel. Patients also stated transport costs and health-care-provider-related reasons, which included perceived/enacted discrimination by health care workers. Other drivers of TI were treatment fatigue/forgetfulness, the patients’ health status, adverse drug effects, pregnancy/delivery, religious belief or perceived/enacted stigma. Conclusions To adequately address patients’ needs on a lifelong therapy, adherence-counselling sessions require provision of problem-solving strategies for common barriers to continuous care.
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Affiliation(s)
- Julia Tabatabai
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Department of Infectious Diseases, Virology, University of Heidelberg, Heidelberg, Germany
| | | | - Hannock Tweya
- The Lighthouse Trust, Lilongwe, Malawi; The International Union against Tuberculosis and Lung Diseases, Paris, France
| | - Sam Phiri
- The Lighthouse Trust, Lilongwe, Malawi
| | - Paul Schnitzler
- Department of Infectious Diseases, Virology, University of Heidelberg, Heidelberg, Germany
| | - Florian Neuhann
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany;
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