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Ganta AG, Wabeto E, Minuta WM, Wegi C, Berheto T, Samuel S, Assele DD. Predictors of loss to follow up among adults on antiretroviral therapy before and after the start of treat-all strategy in public health facilities of Hawassa city, Ethiopia: A Competing risk regression. PLoS One 2024; 19:e0299505. [PMID: 38483944 PMCID: PMC10939213 DOI: 10.1371/journal.pone.0299505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/09/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Treat-all strategies improved patient outcomes, despite higher rates of loss to follow-up compared to the pre-treat era. Patients in Ethiopia experienced a higher rate of LTFU during the treat-all strategy period; however, studies did not identify contributing factors in comparison with previous strategies. This study aimed to assess the incidence and predictors of loss to follow-up before and after the start of the treat-all strategy among adults on anti-retroviral therapy in public health facilities in Hawassa City, Ethiopia. METHODS An institution-based retrospective follow-up study was conducted among 1190 randomly selected adults on antiretroviral therapy in public health facilities in Hawassa City. Using the Open Data Kit (ODK), data were collected from medical records and exported to Stata version 16 and R 4.2.1 for analysis. A Grays test and cumulative incidence curve were used to compare the cumulative incidence function of loss to follow-up. Bivariable and multivariable competing risk regression were fitted to identify predictors of LTFU and variables with a p-value <0.05 were considered significant. RESULTS The cumulative incidence of lost-to-follow-up was 4.92(3.84,6.3) and 8.67(7.26,10.3) per 100 person-years (PY) in pre-treat all and treat all cohorts, respectively. The cumulative incidence of mortality was 5.86(4.67,7.35) and 3(2.26,4.12) per 100 PY in pre-treat and treat all cohorts, respectively. Fair/poor adherence (aSHR:5.17; (95% CI 1.97, 13.51), underweight (aSHR:2.13; 95% CI: 1.15-3.93) and WHO stage III/IV (aSHR:2.69; 95% CI: 1.27, 5.71) were predictors of loss up in pre-treat all, whereas fair/poor adherence (aSHR = 2.07; 95% CI: 1.18, 3.68), underweight (aSHR:1.71; 95% CI: 1.13, 2.56), and CD4 cell >350 cell/m3 (aSHR: 1.67; 95% CI: 1.05, 2.65) predicts of loss up in treat all cohorts. CONCLUSION This study demonstrated that the incidence of loss to follow-up was considerably higher in the treat-all period as compared to the pre-treat-all era. Poor medication compliance, underweight, and a CD4 level >350 cells/m3 contributed to the higher rate of LTFU in the treat-all strategy. Targeted interventions, such as nutritional support and strengthening medication adherence counseling, should be implemented to maintain treatment retention and reduce antiretroviral therapy dropout rates.
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Affiliation(s)
- Abera Gezume Ganta
- Department of Public Health, College of Health Science and Medicine, Jinka University, Jinka, Ethiopia
| | - Ermias Wabeto
- Department of Public Health, College of Health Science and Medicine, Jinka University, Jinka, Ethiopia
| | - Worku Mimani Minuta
- Department of Public Health, College of Health Science and Medicine, Jinka University, Jinka, Ethiopia
| | - Chala Wegi
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Tezera Berheto
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Serawit Samuel
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Desalegn Dawit Assele
- Department of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Benti Biratu S, Addis Gesese A. Determinants of Loss to Follow Up Among Adult People Living with HIV Enrolled in Antiretroviral Therapy in West Wollega Public Hospitals, Oromia, Ethiopia. HIV AIDS (Auckl) 2024; 16:59-71. [PMID: 38435497 PMCID: PMC10906723 DOI: 10.2147/hiv.s426196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
Background Antiretroviral Treatment (ART) reduces morbidity and mortality in patients with human immunodeficiency virus (HIV). However, clients loss to follow-up (LTFU) from the treatment poses a paramount problem to the public, healthcare, and patient outcome. Thus, this study identified determinants of loss to follow-up to ART among adult clients in West Wollega hospitals, Oromia, Ethiopia, in 2021. Methods An unmatched case-control study was conducted and a systematic random sampling technique was used. Data were collected from patient charts by three BSC nurses and three card reporters using a structured checklist. Then, it was entered into Epi-data version 3.1 and analyzed using SPSS version 21. Descriptive statistics (frequency and percentage) were used to present the results. Bivariate and multivariable logistic regression analyses were performed using the backward stepwise method. Adjusted odds ratio (AOR) and p-values <0.05 were used to declare significant association with loss to follow-up. Model fitness was checked using Hosmer-Lemeshow goodness-of-fit. Results A total of 399 (133 patients and 266 controls) participated in this study. Rural residents (AOR:3.46, 95% CI:1.65, 7.25), male patient (AOR: 2.65 95% CI 1.54,4.55), lack of formal education (AOR: 4.35, 95% CI 1.53, 12.41), base line CD4 ≤350 (AOR: 5.25, 95% CI 1.93,14.24), poor functional status (AOR: 4.298, 95% CI 5.33,34.62) and WHO stages III & IV (AOR: 2.65, 95% CI 1.68,4.19), and tuberculosis co-infection (AOR: 2.82, 95% CI 1.11,7.45) were determinant factors of loss to follow up. Conclusion Rural residence, male sex, daily laborer, no formal education, baseline CD4 count <350 cells/mm3, baseline advanced WHO clinical stage, and TB co-infection were determinants of LTFU. Therefore, emphasis should be given to the identified factors along with awareness creation and health education sessions. Regular TB screening, optimal adherence regardless of their stay on ART, and follow-up study are recommended.
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Affiliation(s)
- Siraj Benti Biratu
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Abreha Addis Gesese
- Department of Clinical Nursing, Gambella Teachers Education and Health Science College, Gambella, Ethiopia
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Owachi D, Akatukunda P, Nanyanzi DS, Katwesigye R, Wanyina S, Muddu M, Kawuma S, Kalema N, Kabugo C, Semitala FC. Mortality and associated factors among people living with HIV admitted at a tertiary-care hospital in Uganda: a cross-sectional study. BMC Infect Dis 2024; 24:239. [PMID: 38388345 PMCID: PMC10885437 DOI: 10.1186/s12879-024-09112-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Hospital admission outcomes for people living with HIV (PLHIV) in resource-limited settings are understudied. We describe in-hospital mortality and associated clinical-demographic factors among PLHIV admitted at a tertiary-level public hospital in Uganda. METHODS We performed a cross-sectional analysis of routinely collected data for PLHIV admitted at Kiruddu National Referral Hospital between March 2020 and March 2023. We estimated the proportion of PLHIV who had died during hospitalization and performed logistic regression modelling to identify predictors of mortality. RESULTS Of the 5,827 hospitalized PLHIV, the median age was 39 years (interquartile range [IQR] 31-49) and 3,293 (56.51%) were female. The median CD4 + cell count was 109 cells/µL (IQR 25-343). At admission, 3,710 (63.67%) were active on antiretroviral therapy (ART); 1,144 (19.63%) had interrupted ART > 3 months and 973 (16.70%) were ART naïve. In-hospital mortality was 26% (1,524) with a median time-to-death of 3 days (IQR 1-7). Factors associated with mortality (with adjusted odds ratios) included ART interruption, 1.33, 95% confidence intervals (CI) 1.13-1.57, p 0.001; CD4 + counts ≤ 200 cells/µL 1.59, 95%CI 1.33-1.91, p < 0.001; undocumented CD4 + cell count status 2.08, 95%CI 1.73-2.50, p < 0.001; impaired function status 7.35, 95%CI 6.42-8.41, p < 0.001; COVID-19 1.70, 95%CI 1.22-2.37, p 0.002; liver disease 1.77, 95%CI 1.36-2.30, p < 0.001; co-infections 1.53, 95%CI 1.32-1.78, p < 0.001; home address > 20 km from hospital 1.23, 95%CI 1.04-1.46, p 0.014; hospital readmission 0.7, 95%CI 0.56-0.88, p 0.002; chronic lung disease 0.62, 95%CI 0.41-0.92, p 0.019; and neurologic disease 0.46, 95%CI 0.32-0.68, p < 0.001. CONCLUSION One in four admitted PLHIV die during hospitalization. Identification of risk factors (such as ART interruption, function impairment, low/undocumented CD4 + cell count), early diagnosis and treatment of co-infections and liver disease could improve outcomes.
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Affiliation(s)
- Darius Owachi
- Kiruddu National Referral Hospital, Kampala, P.O. BOX 6588, Uganda.
| | | | | | | | | | - Martin Muddu
- Makerere University Joint AIDS Program, Kampala, Uganda
| | - Samuel Kawuma
- Makerere University Joint AIDS Program, Kampala, Uganda
| | | | - Charles Kabugo
- Kiruddu National Referral Hospital, Kampala, P.O. BOX 6588, Uganda
| | - Fred C Semitala
- Makerere University Joint AIDS Program, Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
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Masaba RO, Herrera N, Siamba S, Ouma M, Okal C, Mayi A, Kose J, Ndimbii J, Ochanda B, Mwangi E, Okomo G, Woelk G. Advanced HIV disease in Homa Bay County, Kenya: Characteristics of newly-diagnosed and antiretroviral therapy-experienced clients. Medicine (Baltimore) 2023; 102:e36716. [PMID: 38134082 PMCID: PMC10735128 DOI: 10.1097/md.0000000000036716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
Advanced HIV disease (AHD) remains a significant burden, despite the widespread use of antiretroviral therapy (ART) programs. Individuals with AHD are at a high risk of death even after starting ART. We characterized treatment naïve and treatment experienced clients presenting with AHD in western Kenya to inform service delivery and program improvement. We conducted a retrospective study using routinely collected program data from October 2016 to September 2019 for AHD clients in eight facilities in Homa Bay County, Kenya. Demographic and clinical data were abstracted from the medical records of AHD clients, defined as HIV-positive clients aged ≥ 5 years with documented CD4 count < 200 cells/mm3 and/or WHO clinical stage II/IV. Associations were assessed using Pearson's chi-square and Mann-Whitney Rank-Sum tests at 5% level of significance. Of the 19,427 HIV clients at the eight facilities, 6649 (34%) had a CD4 count < 200 cells/mm3 or a WHO III/IV stage. Of these, 1845 were randomly selected for analysis. Over half (991) of participants were aged 45 + years and 1040 (56%) were female. The median age was 46.0 years (interquartile range: 39.2-54.5); 1553 (84%) were in care at county and sub-county hospitals; and 1460 (79%) were WHO stage III/IV at enrollment. At ART initiation, 241 (13%) had tuberculosis, 192 (10%) had chronic diarrhea, and 94 (5%) had Pneumocystis jiroveci pneumonia. At the time of data collection, 89 (5%) participants had died and 140 (8%) were lost to follow-up. Eighteen percent (330) of participants were ART-experienced (on ART for ≥ 3 months). The proportions of ART-experienced and -naïve clients regarding age, sex and marital status were similar. However, a higher proportion of ART-experienced clients received care at primary care facilities, (93(28%) vs. 199 (13%); P < .001); were WHO stage 3/4 at AHD diagnosis, 273 (84%) vs. 1187 (79%) (P = .041); and had died or been LTFU, (124 (38%) vs. 105 (7%); P < .001). With increasing prevalence of patients on ART, the proportion of AHD treatment-experienced clients may increase without effective interventions to ensure that these patients remain in care.
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Affiliation(s)
| | - Nicole Herrera
- Elizabeth Glaser Pediatrics AIDS Foundation, Washington, D.C., USA
| | - Stephen Siamba
- Elizabeth Glaser Pediatrics AIDS Foundation, Nairobi , Kenya
| | - Millicent Ouma
- Elizabeth Glaser Pediatrics AIDS Foundation, Nairobi , Kenya
| | | | - Allan Mayi
- Elizabeth Glaser Pediatrics AIDS Foundation, Nairobi , Kenya
| | - Judith Kose
- Elizabeth Glaser Pediatrics AIDS Foundation, Nairobi , Kenya
- Erasmus MC, Department of Viroscience, Rotterdam University, Rotterdam, Netherlands
| | - James Ndimbii
- Elizabeth Glaser Pediatrics AIDS Foundation, Nairobi , Kenya
| | - Boniface Ochanda
- US Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV & TB, Kisumu, Kenya
| | - Eliud Mwangi
- Elizabeth Glaser Pediatrics AIDS Foundation, Nairobi , Kenya
| | | | - Godfrey Woelk
- Elizabeth Glaser Pediatrics AIDS Foundation, Washington, D.C., USA
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Wiebe N, Lloyd A, Crumley ET, Tonelli M. Associations between body mass index and all-cause mortality: A systematic review and meta-analysis. Obes Rev 2023; 24:e13588. [PMID: 37309266 DOI: 10.1111/obr.13588] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/12/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023]
Abstract
Fasting insulin and c-reactive protein confound the association between mortality and body mass index. An increase in fat mass may mediate the associations between hyperinsulinemia, hyperinflammation, and mortality. The objective of this study was to describe the "average" associations between body mass index and the risk of mortality and to explore how adjusting for fasting insulin and markers of inflammation might modify the association of BMI with mortality. MEDLINE and EMBASE were searched for studies published in 2020. Studies with adult participants where BMI and vital status was assessed were included. BMI was required to be categorized into groups or parametrized as non-first order polynomials or splines. All-cause mortality was regressed against mean BMI squared within seven broad clinical populations. Study was modeled as a random intercept. β coefficients and 95% confidence intervals are reported along with estimates of mortality risk by BMIs of 20, 30, and 40 kg/m2 . Bubble plots with regression lines are drawn, showing the associations between mortality and BMI. Splines results were summarized. There were 154 included studies with 6,685,979 participants. Only five (3.2%) studies adjusted for a marker of inflammation, and no studies adjusted for fasting insulin. There were significant associations between higher BMIs and lower mortality risk in cardiovascular (unadjusted β -0.829 [95% CI -1.313, -0.345] and adjusted β -0.746 [95% CI -1.471, -0.021]), Covid-19 (unadjusted β -0.333 [95% CI -0.650, -0.015]), critically ill (adjusted β -0.550 [95% CI -1.091, -0.010]), and surgical (unadjusted β -0.415 [95% CI -0.824, -0.006]) populations. The associations for general, cancer, and non-communicable disease populations were not significant. Heterogeneity was very large (I2 ≥ 97%). The role of obesity as a driver of excess mortality should be critically re-examined, in parallel with increased efforts to determine the harms of hyperinsulinemia and chronic inflammation.
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Affiliation(s)
- Natasha Wiebe
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Anita Lloyd
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Ellen T Crumley
- Rowe School of Business, Dalhousie University, Halifax, Nova Scotia, Canada
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Muinde R, Owuor K, Mutiso J, Mwangi J, Wekesa P. Optimizing HIV case identification: investigating client characteristics predictive of HIV positivity from provider-initiated testing (PITC) in central Kenya. BMC Health Serv Res 2023; 23:1005. [PMID: 37726795 PMCID: PMC10508048 DOI: 10.1186/s12913-023-09876-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 08/04/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Routine program data indicates positivity rates under 2% from HIV testing services (HTS) at sites supported by Centre for Health Solutions-Kenya in Central Kenya. Achieving the UNAIDS 95:95:95 goals requires continuous identification of people living with HIV in an environment of diminishing resources. We assessed non-clinical and clinical characteristics of persons who tested HIV-positive aimed at improving the process of HTS through Provider-Initiated HIV Testing & Counseling (PITC). METHODS We conducted a retrospective analysis of routine PITC program data collected between October 2018 and September 2019 from six health facilities located in three counties in central Kenya. Stratification was based on county and facility volume. A multivariable logistic regression model, clustered adjusted for facility using robust standard errors, was used to determine predictors of a positive HIV result. RESULTS The total sample was 80,693 with an overall positivity rate of 1.2%. Most, (65.5%), were female and 6.1% were < 15 years. Most clients, 55,464 (68.7%), had previously tested for HIV. Client characteristics associated with a higher odds of positivity on multivariable analysis included: being female (adjusted odds ratio [aOR] 1.27, 95% confidence interval [CI] (1.03-1.57); adults 15 years and above compared to children < 15 years, divorced and married polygamous compared to married monogamous [aOR 3.98, 95% CI (2.12-7.29) and aOR 2.41 95% CI (1.48-3.94) respectively]; clients testing for the first time compared to repeat testers in less than 12 months [aOR 1.39, 95% CI (1.27-1.51)]. Similarly, repeat testers in more than 12 months compared to repeat testers in less than 12 months [aOR 1.90, 95% CI (1.55-2.32)]; presumptive TB clients compared to those without signs of TB [aOR 16.25, 95% CI (10.63-24.84)]. Clients tested at inpatient departments (IPD) were more likely to get a positive HIV result compared to those tested at outpatient departments (OPD), and other departments. CONCLUSIONS The study findings highlight client characteristics such as age, marital status, HIV test entry point, first-time test, repeat test after 12 months, and TB status as factors that could influence PITC results and could be used to develop a screening tool to target eligible clients for HTS in low HIV prevalence settings.
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Affiliation(s)
| | | | | | - Jonathan Mwangi
- Division of Global HIV & TB, Center for Global Health, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Paul Wekesa
- Centre for Health Solutions, Nairobi, Kenya.
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Lavoie MCC, Ehoche A, Blanco N, Ahmed El-Imam I, Oladipo A, Dalhatu I, Odafe S, Adebajo S, Ng AH, Rapoport L, Lawton JG, Obanubi C, Onotu D, Patel S, Ikpeazu A, Ashefor G, Adebobola B, Adetinuke Boyd M, Aliyu G, Stafford KA. Effect of Test and Treat on clinical outcomes in Nigeria: A national retrospective study. PLoS One 2023; 18:e0284847. [PMID: 37607206 PMCID: PMC10443836 DOI: 10.1371/journal.pone.0284847] [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: 09/30/2022] [Accepted: 04/10/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND In Nigeria, results from the pilot of the Test and Treat strategy showed higher loss to follow up (LTFU) among people living with HIV compared to before its implementation. The aim of this evaluation was to assess the effects of antiretroviral therapy (ART) initiation within 14 days on LTFU at 12 months and viral suppression. METHODS We conducted a retrospective cohort study using routinely collected de-identified patient-level data hosted on the Nigeria National Data Repository from 1,007 facilities. The study population included people living with HIV age ≥15. We used multivariable Cox proportional frailty hazard models to assess time to LTFU comparing ART initiation strategy and multivariable log-binomial regression for viral suppression. RESULTS Overall, 26,937 (38.13%) were LTFU at 12 months. Among individuals initiated within 14 days, 38.4% were LTFU by 12 months compared to 35.4% for individuals initiated >14 days (p<0.001). In the adjusted analysis, individuals who were initiated ≤14 days after HIV diagnosis had a higher hazard of being LTFU (aHR 1.15, 95% CI 1.10-1.20) than individuals initiated after 14 days of HIV diagnosis. Among individuals with viral load results, 86.2% were virally suppressed. The adjusted risk ratio for viral suppression among individuals who were initiated ≤14 days compared to >14 days was not statistically significant. CONCLUSION LTFU was higher among individuals who were initiated within 14 days compared to greater than 14 days after HIV diagnosis. There was no difference for viral suppression. The provision of early tailored interventions to support newly diagnosed people living may contribute to reducing LTFU.
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Affiliation(s)
- Marie-Claude C Lavoie
- Division of Global Health Sciences, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Center for International Health Education and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Akipu Ehoche
- Center for International Health Education and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Natalia Blanco
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Center for International Health Education and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Ibrahim Ahmed El-Imam
- Center for International Health Education and Biosecurity, MGIC-an Affiliate of the University of Maryland Baltimore, Abuja, Nigeria
| | - Ademola Oladipo
- Centers for Disease Control and Prevention, CGH/DGHT, Abuja, Nigeria
| | - Ibrahim Dalhatu
- Centers for Disease Control and Prevention, CGH/DGHT, Abuja, Nigeria
| | - Solomon Odafe
- Centers for Disease Control and Prevention, CGH/DGHT, Abuja, Nigeria
| | - Sylvia Adebajo
- Center for International Health Education and Biosecurity, MGIC-an Affiliate of the University of Maryland Baltimore, Abuja, Nigeria
| | - Alexia H Ng
- Centers for Disease Control and Prevention, CGH/DGHT, Abuja, Nigeria
| | - Laura Rapoport
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Center for International Health Education and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Jonathan G Lawton
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Center for International Health Education and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | | | - Denis Onotu
- Centers for Disease Control and Prevention, CGH/DGHT, Abuja, Nigeria
| | - Sadhna Patel
- Centers for Disease Control and Prevention, CGH/DGHT, Abuja, Nigeria
| | - Akudo Ikpeazu
- National AIDS and STI Control Programme-Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria
| | - Greg Ashefor
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Bashorun Adebobola
- National AIDS and STI Control Programme-Federal Ministry of Health, Abuja, Federal Capital Territory, Nigeria
| | | | - Gambo Aliyu
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Kristen A Stafford
- Division of Global Health Sciences, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States of America
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Center for International Health Education and Biosecurity, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
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Leno NN, Guilavogui F, Camara A, Kadio KJJO, Guilavogui T, Diallo TS, Diallo MA, Leno DWA, Ricarte B, Koita Y, Kaba L, Ahiatsi A, Touré N, Traoré P, Chaloub S, Kamano A, Vicente CA, Delamou A, Cissé M. Retention and Predictors of Attrition Among People Living With HIV on Antiretroviral Therapy in Guinea: A 13-Year Historical Cohort Study in Nine Large-Volume Sites. Int J Public Health 2023; 68:1605929. [PMID: 37519433 PMCID: PMC10372218 DOI: 10.3389/ijph.2023.1605929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/22/2023] [Indexed: 08/01/2023] Open
Abstract
Objectives: The objective of this study was to estimate the retention rate of patients in an ART program and identify the predictors of attrition. Methods: This was a historical cohort study of HIV patients who started ART between September 2007 and April 2020, and were followed up on for at least 6 months in nine large-volume sites. Kaplan Meier techniques were used to estimate cumulative retention and attrition probabilities. Cox proportional hazards models were used to identify predictors of attrition. Results: The cumulative probability of retention at 12 and 24 months was 76.2% and 70.2%, respectively. The attrition rate after a median follow-up time of 3.1 years was 35.2%, or an incidence of 11.4 per 100 person-years. Having initiated ART between 2012 and 2015; unmarried status; having initiated ART with CD4 count <100 cells/μL; and having initiated ART at an advanced clinical stage were factors significantly associated with attrition. Conclusion: The retention rate in our study is much lower than the proposed national target (90%). Studies to understand the reasons for loss to follow-up are needed.
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Affiliation(s)
- Niouma Nestor Leno
- African Center of Excellence for Prevention and Control of Communicable Diseases (CEA-PCMT), Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
- Department of Public Health, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University Conakry, Conakry, Guinea
- Ministry of Health, Conakry, Guinea
| | - Foromo Guilavogui
- Department of Public Health, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University Conakry, Conakry, Guinea
- Ministry of Health, Conakry, Guinea
- National AIDS and Hepatitis Control Program, Conakry, Guinea
| | - Alioune Camara
- African Center of Excellence for Prevention and Control of Communicable Diseases (CEA-PCMT), Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
- Department of Public Health, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University Conakry, Conakry, Guinea
- National Malaria Control Program, Conakry, Guinea
| | | | - Timothé Guilavogui
- Department of Public Health, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University Conakry, Conakry, Guinea
- Ministry of Health, Conakry, Guinea
| | | | | | | | | | - Youssouf Koita
- National AIDS and Hepatitis Control Program, Conakry, Guinea
| | - Laye Kaba
- National AIDS and Hepatitis Control Program, Conakry, Guinea
| | - Arnold Ahiatsi
- National AIDS and Hepatitis Control Program, Conakry, Guinea
| | - Nagnouman Touré
- National AIDS and Hepatitis Control Program, Conakry, Guinea
| | - Pascal Traoré
- Department of Public Health, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University Conakry, Conakry, Guinea
| | | | - André Kamano
- NGO “Doctors Without Borders Belgium”, Conakry, Guinea
| | | | - Alexandre Delamou
- African Center of Excellence for Prevention and Control of Communicable Diseases (CEA-PCMT), Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University, Conakry, Guinea
- Department of Public Health, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University Conakry, Conakry, Guinea
- National Center for Education and Research in Rural Health Maférinyah, Forécariah, Guinea
| | - Mohamed Cissé
- Department of Dermatology and Sexually Transmitted Infections, Gamal Abdel Nasser University of Conakry Faculty of Health Sciences and Techniques, Conakry, Guinea
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Mayasi Ngongo N, Kamangu Ntambwe E, Situakibanza Nani-Tuma H, Mbula Mambimbi M, Mandina Ndona M, Longokolo Mashi M, Bepouka Izizag B, Lukiana T, Odio Ossam J, Mangala Sonzi D, Maes N, Moutschen M, El Moussaoui M, Darcis G. Human Immunodeficiency Virus Viral Load Monitoring and Rate of Virologic Suppression Among Patients Receiving Antiretroviral Therapy in Democratic Republic of the Congo, 2013-2020. Open Forum Infect Dis 2023; 10:ofad242. [PMID: 37363052 PMCID: PMC10287095 DOI: 10.1093/ofid/ofad242] [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] [Received: 02/28/2023] [Accepted: 05/02/2023] [Indexed: 06/28/2023] Open
Abstract
Background Antiretroviral therapy (ART) expansion and viral load as a treatment monitoring approach have increased the demand for viral load testing. Many hurdles affect the coverage, quality, and use of viral load results. Estimates of viral load monitoring and viral suppression rates are needed to assess the performance of ART programs and improve human immunodeficiency virus (HIV) management outcomes. Methods People with HIV (PWH) viral load monitoring data were routinely collected in 84 health facilities in Kinshasa, Democratic Republic of the Congo (DRC), between 2013 and 2020. The number of PWH under ART, the number of participants with at least 1 viral load test result, the rate of viral suppression (defined as ≤1000 HIV ribonucleic acid copies per mL), and the mean turnaround time from sample collection to release of viral load test results were collected together with clinical data. Results A total of 14 057 PWH were included in the analysis. People with HIV were mainly enrolled after the "test and treat" implementation. The patients were followed for a median period of 27 months. The proportion of PWH with at least 1 available viral load largely increased in recent years. The delay from sample collection to release of viral load test results decreased overtime, from 35 days in 2018 to 16 days in 2020. Pregnancy and advanced HIV disease were associated with a lower chance of viral suppression. Conclusions There has been considerable success in increasing viral load access for all PWH under therapy in DRC. Nevertheless, viral load testing should be intensified with a particular effort to be made in groups at higher risk of viral failure.
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Affiliation(s)
- Nadine Mayasi Ngongo
- Correspondence: Gilles Darcis, MD, PhD, Avenue de l’hôpital 1, 4000 Liège, Belgium (); Nadine Mayasi Ngongo, MD, PhD, Avenue de l’hôpital 1, 4000 Liège, Belgium (nadiamayas02@gmail)
| | - Erick Kamangu Ntambwe
- Department of Molecular Biology of Basic Sciences, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Hippolyte Situakibanza Nani-Tuma
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Marcel Mbula Mambimbi
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Madone Mandina Ndona
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Murielle Longokolo Mashi
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ben Bepouka Izizag
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Tuna Lukiana
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Jérôme Odio Ossam
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Donatien Mangala Sonzi
- Department of Internal Medicine, Infectious and Tropical Diseases, University Hospital of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Nathalie Maes
- Biostatistics and Research Method Center (B-STAT), University Hospital of Liège, Liège, Belgium
| | - Michel Moutschen
- Department of Internal Medicine and Infectious Diseases, Liège University Hospital, Liège, Belgium
- AIDS Reference Laboratory, University of Liège, Liège, Belgium
| | - Majdouline El Moussaoui
- Department of Internal Medicine and Infectious Diseases, Liège University Hospital, Liège, Belgium
| | - Gilles Darcis
- Correspondence: Gilles Darcis, MD, PhD, Avenue de l’hôpital 1, 4000 Liège, Belgium (); Nadine Mayasi Ngongo, MD, PhD, Avenue de l’hôpital 1, 4000 Liège, Belgium (nadiamayas02@gmail)
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Volkow P, Lárraga-Mancilla V, Mendoza MJ, Cornejo-Juárez P, Islas-Muñoz B, Pérez-Jiménez C, Alatorre-Fernández P, Martin-Onraet A. Impact of COVID-19 pandemic in the care of people living with HIV and cancer at an oncologic center in Mexico. Int J STD AIDS 2023; 34:159-167. [PMID: 36527188 PMCID: PMC9760499 DOI: 10.1177/09564624221142364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND People living with HIV(PLWH) and cancer are among the most vulnerable patients and require constant access to medical services. We compared the characteristics of PLWH and cancer in Mexico, before and during the COVID-19 pandemic. METHODS Patients admitted 1 year before (pre-pandemic) and 1 year after the start of the pandemic (pandemic) were included. Clinical characteristics, HIV-related variables, and 90-day mortality were compared. Data are described a proportions (N,%) and central tendency measures. A multiple regression model for variables associated with 90-day mortality was performed. RESULTS Seventy-nine patients were seen in the pre-pandemic period; 92 during the pandemic. Main diagnoses were Kaposi Sarcoma and lymphoma. CD4+ cell count at diagnosis was lower during the pandemic: 81 cells/mm3 vs. 128 cells/mm3, p = .035. CD4+<100 cells/mm3 at first consultation increased from 41% to 58% during the pandemic (p = .041). Only BMI <20 kg/m2 was associated to death (aOR 8.27, 95%CI 1.74-39.25) (p = .008). The pandemic period was not associated with a higher 90-day mortality. CONCLUSIONS PLWH and cancer presented to care with advanced disease overall. This was more pronounced during the pandemic period. Mortality was associated with AIDS-related variables regardless of study period. This underscores the need for strategies to maintain in-person access to health-care services for PLWH.
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Affiliation(s)
| | | | | | | | | | | | | | - Alexandra Martin-Onraet
- Alexandra Martin-Onraet, Infectious
Diseases Department, Instituto Nacional de Cancerología (INCan), Av. San
Fernando No. 22, Col. Belisario Domínguez, Sección XVI, Tlalpan, Ciudad de
México 14080, México.
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Lewis-Kulzer J, Mburu M, Obatsa S, Cheruiyot J, Kiprono L, Brown S, Apaka C, Koros H, Muyindike W, Kwobah EK, Diero L, Aluda M, Wools-Kaloustian K, Goodrich S. Patient perceptions of facilitators and barriers to reducing hazardous alcohol use among people living with HIV in East Africa. Subst Abuse Treat Prev Policy 2023; 18:8. [PMID: 36737735 PMCID: PMC9896687 DOI: 10.1186/s13011-023-00520-7] [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: 08/25/2022] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hazardous alcohol use among people living with HIV is associated with poor outcomes and increased morbidity and mortality. Understanding the hazardous drinking experiences of people living with HIV is needed to reduce their alcohol use. METHODS We conducted 60 interviews among people living with HIV in East Africa with hazardous drinking histories. Interviews and Alcohol Use Disorder Identification Test (AUDIT) scores were conducted 41 - 60 months after their baseline assessment of alcohol use to identify facilitators and barriers to reduced alcohol use over time. RESULTS People living with HIV who stopped or reduced hazardous drinking were primarily motivated by their HIV condition and desire for longevity. Facilitators of reduced drinking included health care workers' recommendations to reduce drinking (despite little counseling and no referrals) and social support. In those continuing to drink at hazardous levels, barriers to reduced drinking were stress, social environment, alcohol accessibility and alcohol dependency. CONCLUSIONS Interventions that capacity-build professional and lay health care workers with the skills and resources to decrease problematic alcohol use, along with alcohol cessation in peer support structures, should be explored.
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Affiliation(s)
- Jayne Lewis-Kulzer
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, 550 16TH Street, 3rd Floor, San Francisco, CA, USA.
| | - Margaret Mburu
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 1578-40100, Kisumu, Kenya
| | - Sarah Obatsa
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 1578-40100, Kisumu, Kenya
| | - Julius Cheruiyot
- Academic Model Providing Access to Health Care (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - Lorna Kiprono
- Academic Model Providing Access to Health Care (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - Steve Brown
- Department of Biostatistics and Health Data Science, School of Medicine, Indiana University, 410 W. 10th Street, HITS 3000, Indianapolis, IN, USA
| | - Cosmas Apaka
- Academic Model Providing Access to Health Care (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - Hillary Koros
- Academic Model Providing Access to Health Care (AMPATH), P.O. Box 4606-30100, Eldoret, Kenya
| | - Winnie Muyindike
- The Immune Suppression Syndrome Clinic, Mbarara University of Science and Technology, P.O. Box 40, Mbarara, Uganda
| | - Edith Kamaru Kwobah
- Department of Mental Health, Moi Teaching and Referral Hospital, P.O. Box 3-30100, Eldoret, Kenya
| | - Lameck Diero
- Department of Medicine, Moi University School of Medicine, P.O. Box 4606-30100, Eldoret, Kenya
| | - Maurice Aluda
- Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 1578-40100, Kisumu, Kenya
| | - Kara Wools-Kaloustian
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Indiana University, 545 Barnhill Drive, Indianapolis, IN, USA
| | - Suzanne Goodrich
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Indiana University, 545 Barnhill Drive, Indianapolis, IN, USA
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Alebel A, Sibbritt D, Petrucka P, Demant D. Undernutrition increased the risk of loss to follow-up among adults living with HIV on ART in Northwest Ethiopia: a retrospective cohort study. Sci Rep 2022; 12:22556. [PMID: 36581708 PMCID: PMC9800382 DOI: 10.1038/s41598-022-27077-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022] Open
Abstract
This study aims to examine the effect of undernutrition on loss to follow-up (LTFU) in adults living with human immunodeficiency virus (HIV) receiving antiretroviral therapy (ART) in Ethiopia. We conducted an institution-based retrospective cohort study using medical records of 844 adults living with HIV receiving ART between June 2014 and June 2020 at Debre Markos Comprehensive Specialized Hospital (Northwest Ethiopia). The effect of undernutrition on LTFU was examined using a proportional hazards regression model after adjusting potential confounders. The significance level was set at p < 0.05. At the end of the study period, 109 (12.9%) participants were considered LTFU, with an overall LTFU incidence of 5.3 per 100 person-years (95% CI 4.4, 6.4). The incidence of LTFU was higher in undernourished participants (8.2 per 100 person-years) compared to well-nourished participants (4.3 per 100 person-years). After adjusting for potential confounders, the adjusted risk of LTFU among undernourished participants was two times higher than in their well-nourished counterparts (AHR [adjusted hazard ratio]: 2.1, 95% CI 1.4, 3.2). This study found that undernutrition significantly increased the risk of LTFU among adults living with HIV on ART.
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Affiliation(s)
- Animut Alebel
- grid.449044.90000 0004 0480 6730College of Health Science, Debre Markos University, Debre Markos, Ethiopia ,grid.117476.20000 0004 1936 7611School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW Australia
| | - David Sibbritt
- grid.117476.20000 0004 1936 7611School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW Australia
| | - Pammla Petrucka
- grid.25152.310000 0001 2154 235XCollege of Nursing, University of Saskatchewan, Saskatoon, Canada ,grid.451346.10000 0004 0468 1595School of Life Sciences and Bioengineering, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
| | - Daniel Demant
- grid.117476.20000 0004 1936 7611School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW Australia ,grid.1024.70000000089150953School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD Australia
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Wachira J, Mwangi A, Genberg B, Ngeresa A, Galárraga O, Kimayo S, Dick J, Braitstein P, Wilson I, Hogan J. Continuity of Care is Associated with Higher Appointment Adherence Among HIV Patients in Low Clinician-to-Patient Ratio Facilities in Western Kenya. AIDS Behav 2022; 26:3516-3523. [PMID: 35467227 DOI: 10.1007/s10461-022-03686-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 11/27/2022]
Abstract
We sought to determine the relationship between continuity of care and adherence to clinic appointments among patients receiving HIV care in high vs. low clinician-to-patient (C:P) ratios facilities in western Kenya. This retrospective analysis included 12,751 patients receiving HIV care from the Academic Model Providing Access to Healthcare (AMPATH) program, between February 2016-2019. We used logistic regression analysis with generalized estimating equations to estimate the relationship between continuity of care (two consecutive visits with the same provider) and adherence to clinic appointments (within 7 days of a scheduled appointment) over time. Adjusting for covariates, patients in low C:P ratio facilities who had continuity of care, were more likely to be adherent to their appointments compared to those without continuity (adjusted odds ratio = 1.50; 95% confidence interval, 1.33-1.69). Continuity in HIV care may be a factor in clinical adherence among patients in low C:P ratio facilities and should therefore be promoted.
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Affiliation(s)
- Juddy Wachira
- Department of Mental Health & Behavioral Sciences, School of Medicine, College of Health Sciences, Moi University Eldoret, P.O Box 4604-30100, Eldoret, Kenya.
- Department of Media Studies, School of Literature, Language and Media, University of Witwatersrand, Johannesburg, South Africa.
| | - Ann Mwangi
- Department of Maths, Physics and Computing, School of Science and Aerospace Studies, Moi University, Eldoret, Kenya
| | - Becky Genberg
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Anthony Ngeresa
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Omar Galárraga
- Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Sylvester Kimayo
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Jonathan Dick
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Paula Braitstein
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ira Wilson
- Department of Health Services, Policy & Practice, School of Public Health, Brown University, Providence, RI, USA
| | - Joseph Hogan
- Department of Biostatistics, School of Public Health, Brown University, Providence, RI, USA
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Ntabanganyimana D, Rugema L, Omolo J, Nsekuye O, Malamba SS. Incidence and factors associated with being lost to follow-up among people living with HIV and receiving antiretroviral therapy in Nyarugenge the central business district of Kigali city, Rwanda. PLoS One 2022; 17:e0275954. [PMID: 36228004 PMCID: PMC9562217 DOI: 10.1371/journal.pone.0275954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/26/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Lost to follow-up (LTFUP) continues to threaten the sustainability of antiretroviral therapy (ART) benefits and success of ART programs. We determined the incidence and predictors of LTFUP among people living with HIV (PLHIV) on ART in Nyarugenge the Central Business District of Kigali city. METHODS A cohort of PLHIV who initiated ART in 2018 was retrospectively studied for 24 months. Using health facility records, a person who had no record of contact with the health facility for at least three consecutive months was considered LTFUP. LTFUP incidence rates were computed, and the Fine-Gray's competing risk regression models were used to determine factors associated with time to first LTFUP. Generalized estimating equations (GEEs) were used to analyze repeated measurement outcomes of LTFUP and predictors of LTFUP. RESULTS Of 950 participants, 581 (61.2%) were females and 866 (91.2%) were 15 to 49 years old. From 1,586.1 person years of observation (pyo), 148 participants got LTFUP for 451 times. The incidence rate to first event was 9.4 per 100 pyo (95%CI:7.9-10.9) and 31.8 per 100 pyo (95%CI:29.0-34.4) to multiple events. WHO stage, marital status, employment status and person to contact when PLHIV is not reachable were associated with time to first LTFUP event. However, an average participant with a contact person who was not a Community Health Worker (CHW) or a peer educator had higher incidence of LTUP (aIRR = 2.69, 95%CI: 1.43-5.06), an average single patients had higher incidence of LTFUP (aIRR = 1.74, 95%CI: 1.28-2.34) compared to married/co-habiting, and an average self-employed had higher incidence of LTFUP (aIRR = 1.51, 95%CI: 1.14-2.01) compared to participants employed by others. Furthermore, an average PLHIV living out-of-the health facility catchment area had higher incidence of LTFUP (aIRR = 1.55, 95%CI: 1.19-2.01) compared to an average PLHIV living in the health facility catchment area whereas, an average children initiated on first line had lower incidence of LTUP (aIRR = 0.43, 95%CI: 0.21-0.86) compared to adults. CONCLUSION Using CHW and peer educators as contact persons can help to reduce LTFUP while, targeted sensitization and service delivery are needed for single, self-employed and, patients living out of the health facility catchment area.
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Affiliation(s)
- Daniel Ntabanganyimana
- Rwanda Field Epidemiology and Laboratory Training Program, Department of Epidemiology and Biostatistics, University of Rwanda, Kigali, Rwanda
- Ministry of Health, Kigali, Rwanda
- * E-mail:
| | - Lawrence Rugema
- University of Rwanda/School of Public Health, Kigali, Rwanda
| | - Jared Omolo
- CGH DGHT, Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Olivier Nsekuye
- Rwanda Field Epidemiology and Laboratory Training Program, Department of Epidemiology and Biostatistics, University of Rwanda, Kigali, Rwanda
- Rwanda Biomedical Centre, Public Health Surveillance & Emergency Preparedness and Response, Kigali, Rwanda
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Factors Associated with Retention of HIV Patients on Antiretroviral Therapy in Care: Evidence from Outpatient Clinics in Two Provinces of the Democratic Republic of the Congo (DRC). Trop Med Infect Dis 2022; 7:tropicalmed7090229. [PMID: 36136640 PMCID: PMC9504336 DOI: 10.3390/tropicalmed7090229] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 12/02/2022] Open
Abstract
Interruptions in the continuum of care for HIV can inadvertently increase a patient’s risk of poor health outcomes such as uncontrolled viral load and a greater likelihood of developing drug resistance. Retention of people living with HIV (PLHIV) in care and determinants of attrition, such as adherence to treatment, are among the most critical links strengthening the continuum of care, reducing the risk of treatment failure, and assuring viral load suppression. Objective: To analyze the variation in, and factors associated with, retention of patients enrolled in HIV services at outpatient clinics in the provinces of Kinshasa and Haut-Katanga, Democratic Republic of the Congo (DRC). Methods: Data for the last visit of 51,286 patients enrolled in Centers for Disease Control (CDC)-supported outpatient HIV clinics in 18 health zones in Haut-Katanga and Kinshasa, DRC were extracted in June 2020. Chi-square tests and multivariable logistic regressions were performed. Results: The results showed a retention rate of 78.2%. Most patients were classified to be at WHO clinical stage 1 (42.1%), the asymptomatic stage, and only 3.2% were at stage 4, the severest stage of AIDS. Odds of retention were significantly higher for patients at WHO clinical stage 1 compared to stage 4 (adjusted odds ratio (AOR), 1.325; confidence interval (CI), 1.13−1.55), women as opposed to men (AOR, 2.00; CI, 1.63−2.44), and women who were not pregnant (vs. pregnant women) at the start of antiretroviral therapy (ART) (AOR, 2.80; CI, 2.04−3.85). Odds of retention were significantly lower for patients who received a one-month supply rather than multiple months (AOR, 0.22; CI, 0.20−0.23), and for patients in urban health zones (AOR, 0.75; CI, 0.59−0.94) rather than rural. Compared to patients 55 years of age or older, the odds of retention were significantly lower for patients younger than 15 (AOR, 0.35; CI, 0.30−0.42), and those aged 15 and <55 (AOR, 0.75; CI, 0.68−0.82). Conclusions: Significant variations exist in the retention of patients in HIV care by patient characteristics. There is evidence of strong associations of many patient characteristics with retention in care, including clinical, demographic, and other contextual variables that may be beneficial for improvements in HIV services in DRC.
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Wekesa P, McLigeyo A, Owuor K, Mwangi J, Ngugi E. Survival probability and factors associated with time to loss to follow-up and mortality among patients on antiretroviral treatment in central Kenya. BMC Infect Dis 2022; 22:522. [PMID: 35668350 PMCID: PMC9171980 DOI: 10.1186/s12879-022-07505-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Retention of patients who are receiving antiretroviral therapy (ART) remains a challenge especially in the setting of rapid expansion of HIV services. Retention in care remains vital to the HIV care continuum, and has been associated with viral suppression and improved survival. This study aimed to ascertain survival rates, time to loss to follow-up (LTFU) or mortality events and factors associated with time to LTFU or mortality among patients enrolled on antiretroviral therapy at health facilities in central Kenya. METHODS This was a retrospective cohort study among patients initiated on ART between 2004 and 2012 in central Kenya. Demographic characteristics, clinical characteristics and outcomes data were analyzed using Stata version 15.1. Competing risks regression analysis and cummulative incidence functions were used to estimate survival. RESULTS A total of 31,346 patients were included, of whom 65.6% were female, 76.0% were aged between 20 and 50 years old, and 38.9% were diagnosed at WHO stage III. At 36 months, overall retention was 68.8%, LTFU was 27.1%, and mortality was 4.1%. The total person-years of follow up was 74,986. The incidence rate of LTFU was 9.99 per 100 person years for a total of 9383.25 person-years of follow up. The mortality rate was 1.25 per 100 person years for a total of 875.5 person-years among those who died. The median time to LTFU was 11 months (IQR 3-22) while median time to death was 3 months (IQR 0-13). Men, unmarried patients, patients presenting with advanced HIV, not on TB treatment, and enrolled into the HIV program in later cohorts, had a shorter time to mortality and LTFU. CONCLUSION Our study demonstrated evidence of scale-up of HIV treatment programs in central Kenya. While most patients were enrolled at an advanced WHO clinical stage, overall 36-month mortality remained low, but occurred earlier during follow-up. Cohort LTFU at 36-months reduced in later years with the losses occurring within the 1st year of follow-up. Predictors of early mortality and LTFU included being male, single, separated or divorced, advanced WHO clinical stage, and among patients not on TB treatment.
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Affiliation(s)
- P Wekesa
- Centre for Health Solutions - Kenya, Nairobi, Kenya.
| | - A McLigeyo
- Centre for Health Solutions - Kenya, Nairobi, Kenya
| | - K Owuor
- Centre for Health Solutions - Kenya, Nairobi, Kenya
| | - J Mwangi
- Division of Global HIV & TB, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - E Ngugi
- Division of Global HIV & TB, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
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Samba BO, Lewis-Kulzer J, Odhiambo F, Juma E, Mulwa E, Kadima J, Bukusi EA, Cohen CR. Exploring Estimates and Reasons for Lost to Follow-Up Among People Living With HIV on Antiretroviral Therapy in Kisumu County, Kenya. J Acquir Immune Defic Syndr 2022; 90:146-153. [PMID: 35213856 PMCID: PMC9203903 DOI: 10.1097/qai.0000000000002942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 02/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND A better understanding why people living with HIV (PLHIV) become lost to follow-up (LTFU) and determining who is LTFU in a program setting is needed to attain HIV epidemic control. SETTING This retrospective cross-sectional study used an evidence-sampling approach to select health facilities and LTFU patients from a large HIV program supporting 61 health facilities in Kisumu County, Kenya. METHODS Eligible PLHIV included adults 18 years and older with at least 1 clinic visit between September 1, 2016, and August 31, 2018, and were LTFU (no clinical contact for ≥90 days after their last expected clinic visit). From March to June 2019, demographic and clinical variables were collected from a sample of LTFU patient files at 12 health facilities. Patient care status and retention outcomes were determined through program tracing. RESULTS Of 787 LTFU patients selected and traced, 36% were male, median age was 30.5 years (interquartile range: 24.6-38.0), and 78% had their vital status confirmed with 560 (92%) alive and 52 (8%) deceased. Among 499 (89.0%) with a retention outcome, 233 (46.7%) had stopped care while 266 (53.3%) had self-transferred to another facility. Among those who had stopped care, psychosocial reasons were most common {65.2% [95% confidence interval (CI): 58.9 to 71.1]} followed by structural reasons [29.6% (95% CI: 24.1 to 35.8)] and clinic-based reasons [3.0% (95% CI: 1.4 to 6.2)]. CONCLUSION We found that more than half of patients LTFU were receiving HIV care elsewhere, leading to a higher overall patient retention rate than routinely reported. Similar strategies could be considered to improve the accuracy of reporting retention in HIV care.
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Affiliation(s)
- Benard O Samba
- Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Jayne Lewis-Kulzer
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA; and
| | - Francesca Odhiambo
- Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Eric Juma
- Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Edwin Mulwa
- Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Julie Kadima
- Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Elizabeth A Bukusi
- Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Craig R Cohen
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA; and
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Nshimirimana C, Ndayizeye A, Smekens T, Vuylsteke B. Loss to follow-up of patients in HIV care in Burundi: A retrospective cohort study. Trop Med Int Health 2022; 27:574-582. [PMID: 35411666 DOI: 10.1111/tmi.13753] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective was to assess the loss to follow-up (LTFU) rates and associated factors amongst patients in HIV care in Burundi. METHODS We conducted a retrospective cohort study in HIV-positive patients aged ≥15 years who started antiretroviral therapy (ART) between January 2015 and July 2020, with 31 December 2020 as the end point. The outcome of LTFU was defined as failure of a patient to report for drug refill within 90 days from the last appointment. Study data were extracted from the national AIDS Info database. The LTFU proportion was determined using the Kaplan-Meier method with the log-rank test, whereas LTFU risk factors were explored using the Cox regression model. RESULTS A total of 29,829 patients on ART were included in the analysis. Cumulative incidence of LTFU was 2.3% at 12 months, 6.5% at 24 months, 12.7% at 36 months, 19.0% at 48 months, 24.1% at 60 months and 25.3% at 72 months. The overall LTFU incidence rate was 11.2 per 100 person-years of observation. The risk of LTFU was higher amongst patients who started ART after 2016 (adjusted hazard ratio [aHR] 1.75, 95% confidence interval [CI] 1.65-1.85) or within 7 days after diagnosis (aHR 1.27, 95% CI 1.21-1.35). CONCLUSION Our findings demonstrate the relatively high incidence of LTFU in the Burundi HIV programme. Interventions targeting patients with risk factors for LTFU are particularly necessary.
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Affiliation(s)
| | - Aimé Ndayizeye
- HIV/STIs Burundi National Program, Ministry of Public Health, Bujumbura, Burundi
| | - Tom Smekens
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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McLigeyo A, Wekesa P, Owuor K, Mwangi J, Isavwa L, Mutisya I. Factors Associated with Treatment Outcomes Among Children and Adolescents Living with HIV Receiving Antiretroviral Therapy in Central Kenya. AIDS Res Hum Retroviruses 2022; 38:480-490. [PMID: 35229643 PMCID: PMC9225829 DOI: 10.1089/aid.2021.0112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Expanded access to HIV treatment services has improved outcomes for children and adolescents living with HIV in Kenya. Minimal data are available on these outcomes. We describe temporal trends in outcomes for children and adolescents initiating antiretroviral therapy (ART) from 2004 to 2014 at sites supported by Centre for Health Solutions—Kenya, in central Kenya. We retrospectively analyzed data from children 0–9 years of age (n = 3,519) and adolescents 10–19 years of age (n = 1,663) living with HIV, who newly initiated ART at 47 health facilities in central Kenya. Year cohorts were analyzed from the Comprehensive Patient Application Database (CPAD) and International Quality Care (IQCare) electronic medical databases, including temporal trends in outcomes and associated factors using multivariable competing risk regression analysis. There were more girls (2,453 [52.7%]) than boys, with most enrolled at World Health Organization (WHO) stage II (1,813 [37.7%]) or III disease (1,694 [35.1%]). Most of the children and adolescents (4,431 [96.4%]) did not have tuberculosis (TB) symptoms. Cumulative lost to follow-up (LTFU) incidence at 6, 12, 24, and 36 months were 5.0%, 9.9%, 22.9%, and 33.1%, respectively. Cumulative mortality incidence at 6, 12, 24, and 36 months were 0.7%, 1.0%, 1.2%, and 1.5%, respectively. The incidence of LTFU was higher among female children and adolescents, those initiated on tenofovir-based regimens, and those with presumptive TB symptoms. Mortality risk was higher among those with WHO stage III or IV disease, and children and adolescents on TB treatment or who had presumptive TB. Enrollment occurred at a young age and pediatric-friendly ART regimens were initiated at earlier WHO stages implying effective early infant diagnosis and treatment for all strategies, resulting in improved treatment outcomes. The higher retention rates in recent years as well as the lower retention after many years of follow-up underscore the importance of implementing longitudinal follow-up strategies targeting this population.
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Affiliation(s)
| | - Paul Wekesa
- Centre for Health Solutions—Kenya (CHS), Nairobi, Kenya
| | - Kevin Owuor
- Centre for Health Solutions—Kenya (CHS), Nairobi, Kenya
| | - Jonathan Mwangi
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Linda Isavwa
- Centre for Health Solutions—Kenya (CHS), Nairobi, Kenya
| | - Immaculate Mutisya
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Nairobi, Kenya
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20
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McLigeyo A, Owuor K, Ng’ang’a E, Mwangi J, Wekesa P. Characteristics and Treatment Response of Patients with HIV Associated Kaposi's Sarcoma in Central Kenya. HIV AIDS (Auckl) 2022; 14:207-215. [PMID: 38808105 PMCID: PMC11130515 DOI: 10.2147/hiv.s359278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/01/2022] [Indexed: 05/30/2024] Open
Abstract
Introduction Kaposi's sarcoma (KS) is the most common HIV-associated malignancy in Sub Saharan Africa. In 2018, it was the 7th most common cancer and the 10th most common cause of cancer death in Kenya. This study aimed to describe the baseline and clinical characteristics and treatment response observed following combined antiretroviral treatment (ART) and chemotherapy in KS patients. Methods This was a descriptive analysis of patients aged ≥15 years treated for KS and HIV at 11 treatment hubs in Central Kenya between 2011 and 2014. Data on baseline and clinical characteristics, ART and chemotherapy regimens as well as treatment responses were collected from patient files and KS registers. Results A total of 95 patients presenting with clinically suspected KS with no history of prior treatment with chemotherapy were reviewed. All had histological diagnostic samples taken with 67 (71%) having confirmed KS. All were on ART, either newly initiated or continuing on ART, and 63 of the 67 (94.0%) confirmed to have KS received chemotherapy. Among the 67 patients with confirmed KS, mean age was 37.2 years (± 13.2) and 40 (59.7%) were male. More than 80% had normal baseline and follow-up BMI, and 34 (50.7%) were on a TDF-based regimen, 52 (77.6%) were treated with the Adriamycin, bleomycin and vinblastine protocol, and 55 (82.1%) had KS diagnosis before HIV diagnosis. All 67 patients had mucocutaneous lesions. Complete, partial response and stable disease occurred in 27 (40.3%), 10 (14.9%) and 7 (10.4%), respectively, 11 (16.4%) defaulted care during treatment, six patients died during treatment, four patients died before treatment while two patients had progressive disease during chemotherapy. Conclusion The diagnosis of KS preceded HIV in the majority of cases reviewed, with histology helpful to reduce misdiagnosis. Patients generally complied with their chemotherapy, with overall good response rate for this intervention implemented at primary health-care facilities.
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Affiliation(s)
| | - Kevin Owuor
- Center for Health Solutions - Kenya, Nairobi, Kenya
| | | | - Jonathan Mwangi
- Division of Global HIV & TB, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Paul Wekesa
- Center for Health Solutions - Kenya, Nairobi, Kenya
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21
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Mayasi N, Situakibanza H, Mbula M, Longokolo M, Maes N, Bepouka B, Ossam JO, Moutschen M, Darcis G. Retention in care and predictors of attrition among HIV-infected patients who started antiretroviral therapy in Kinshasa, DRC, before and after the implementation of the 'treat-all' strategy. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000259. [PMID: 36962315 PMCID: PMC10022330 DOI: 10.1371/journal.pgph.0000259] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 02/13/2022] [Indexed: 11/18/2022]
Abstract
The retention of patients in care is a key pillar of the continuum of HIV care. It has been suggested that the implementation of a "treat-all" strategy may favor attrition (death or lost to follow-up, as opposed to retention), specifically in the subgroup of asymptomatic people living with HIV (PLWH) with high CD4 counts. Attrition in HIV care could mitigate the success of universal antiretroviral therapy (ART) in resource-limited settings. We performed a retrospective study of PLWH at least 15 years old initiating ART in 85 HIV care centers in Kinshasa, Democratic Republic of Congo (DRC), between 2010 and 2019, with the objective of measuring attrition and to define factors associated with it. Sociodemographic and clinical characteristics recorded at ART initiation included sex, age, weight, height, WHO HIV stage, pregnancy, baseline CD4 cell count, start date of ART, and baseline and last ART regimen. Attrition was defined as death or loss to follow-up (LTFU). LTFU was defined as "not presenting to an HIV care center for at least 180 days after the date of a last missed visit, without a notification of death or transfer". Kaplan-Meier curves were used to present attrition data, and mixed effects Cox regression models determined factors associated with attrition. The results compared were before and after the implementation of the "treat-all" strategy. A total of 15,762 PLWH were included in the study. Overall, retention in HIV care was 83% at twelve months and 77% after two years of follow-up. The risk of attrition increased with advanced HIV disease and the size of the HIV care center. Time to ART initiation greater than seven days after diagnosis and Cotrimoxazole prophylaxis was associated with a reduced risk of attrition. The implementation of the "treat-all" strategy modified the clinical characteristics of PLWH toward higher CD4 cell counts and a greater proportion of patients at WHO stages I and II at treatment initiation. Initiation of ART after the implementation of the 'treat all" strategy was associated with higher attrition (p<0.0001) and higher LTFU (p<0.0001). Attrition has remained high in recent years. The implementation of the "treat-all" strategy was associated with higher attrition and LTFU in our study. Interventions to improve early and ongoing commitment to care are needed, with specific attention to high-risk groups to improve ART coverage and limit HIV transmission.
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Affiliation(s)
- Nadine Mayasi
- Department of Internal Medicine, Infectious and Tropical Diseases, University Clinics of Kinshasa, Kinshasa, Democratic Republic of the Congo [DRC]
| | - Hippolyte Situakibanza
- Department of Internal Medicine, Infectious and Tropical Diseases, University Clinics of Kinshasa, Kinshasa, Democratic Republic of the Congo [DRC]
| | - Marcel Mbula
- Department of Internal Medicine, Infectious and Tropical Diseases, University Clinics of Kinshasa, Kinshasa, Democratic Republic of the Congo [DRC]
| | - Murielle Longokolo
- Department of Internal Medicine, Infectious and Tropical Diseases, University Clinics of Kinshasa, Kinshasa, Democratic Republic of the Congo [DRC]
| | - Nathalie Maes
- Biostatistics and Medico-Economic Information Department, University Hospital of Liège, Liège, Belgium
| | - Ben Bepouka
- Department of Internal Medicine, Infectious and Tropical Diseases, University Clinics of Kinshasa, Kinshasa, Democratic Republic of the Congo [DRC]
| | - Jérôme Odio Ossam
- Department of Internal Medicine, Infectious and Tropical Diseases, University Clinics of Kinshasa, Kinshasa, Democratic Republic of the Congo [DRC]
| | - Michel Moutschen
- Department of Internal Medicine and Infectious Diseases, Liège University Hospital, Liège, Belgium
- AIDS Reference Laboratory, University of Liège, Liège, Belgium
| | - Gilles Darcis
- Department of Internal Medicine and Infectious Diseases, Liège University Hospital, Liège, Belgium
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22
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Alebel A, Demant D, Petrucka P, Sibbritt D. Does undernutrition increase the risk of lost to follow-up in adults living with HIV in sub-Saharan Africa? Protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e048022. [PMID: 34907042 PMCID: PMC8671928 DOI: 10.1136/bmjopen-2020-048022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Undernutrition is considered a marker for poor prognosis among people living with HIV (PLHIV), particularly in sub-Saharan Africa (SSA), where undernutrition and HIV are both highly prevalent. Evidence suggests that undernutrition (body mass index <18.5 kg/m2) is one of the main factors that significantly increases the risk of lost to follow-up (LTFU) in PLHIV. However, primary studies in SSA have reported inconsistent findings on the relationship between undernutrition and LTFU among adults living with HIV. To the best of our knowledge, no systematic review which aimed to summarise the available evidence. Hence, this review aims to determine the pooled effect of undernutrition on LTFU among adults living with HIV in SSA. METHODS AND ANALYSIS PubMed, EMBASE, Web of Science, Scopus, and, for grey literature, Google Scholar will be systematically searched to include relevant articles published since 2005. Studies reporting the effect of undernutrition on LTFU in adults living with HIV in SSA will be included. The Newcastle-Ottawa Scale will be used for quality assessment. Data from eligible studies will be extracted using a standardised data extraction tool. Heterogeneity between included studies will be assessed using Cochrane Q-test and I2 statistics. The Egger's and Begg's tests at a 5% significance level will be used to evaluate publication bias. As heterogeneity is anticipated, the pooled effect size will be estimated using a random-effects model. The final effect size will be reported using the adjusted HR with a 95% CI. ETHICS AND DISSEMINATION Ethical approval is not required for a protocol for a systematic review. The results of this systematic review will be published in a peer-reviewed journal and will be publicly available. PROSPERO REGISTRATION NUMBER CRD42021277741.
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Affiliation(s)
- Animut Alebel
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- School of Public Helath, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Daniel Demant
- School of Public Helath, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Pammla Petrucka
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
| | - David Sibbritt
- School of Public Helath, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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Wekesa P, McLigeyo A, Owuor K, Mwangi J, Isavwa L, Katana A. Temporal trends in pre-ART patient characteristics and outcomes before the test and treat era in Central Kenya. BMC Infect Dis 2021; 21:1007. [PMID: 34565337 PMCID: PMC8474838 DOI: 10.1186/s12879-021-06706-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/16/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Retention of patients who did not initiate antiretroviral therapy (ART) has been persistently low compared to those who initiated ART. Understanding the temporal trends in clinical outcomes prior to ART initiation may inform interventions targeting patients who do not initiate ART immediately after diagnosis. METHODS A retrospective cohort analysis of known HIV-infected patients who did not initiate ART from healthcare facilities in Central Kenya was done to investigate temporal trends in characteristics, retention, and mortality outcomes. The data were sourced from the Comprehensive Care Clinic Patient Application Database (CPAD) and IQ care electronic patient-level databases for those enrolled between 2004 and 2014. RESULTS A total of 13,779 HIV-infected patients were assessed, of whom 30.7% were men.There were statisitically significant differences in temporal trends relating to marital status, WHO clinical stage, and tuberculosis (TB) status from 2004 to 2014. The proportion of widowed patients decreased from 9.1 to 6.0%. By WHO clinical stage at enrollment in program, those in WHO stage I increased over time from 8.7 to 43.1%, while those in WHO stage III and IV reduced from 28.5 to 10.8% and 4.0 to 1.1% respectively. Those on TB treatment during their last known visit reduced from 8.3 to 3.9% while those with no TB signs increased from 58.5 to 86.8%. Trends in 6 and 12 month retention in the program, loss to follow-up (LTFU) and mortality were statistically significant. At 6 months, program retention ranged between 36.0% in 2004 to a high of 54.1% in 2013. LTFU at 6 months remained around 50.0% for most of the cohorts, while mortality at 6 months was 7.5% in 2004 but reduced to 3.8% in 2014. At 12 months, LTFU was above 50.0% across all the cohorts while mortality rate reached 3.9% in 2014. CONCLUSION Trends in pre ART enrollment suggested higher enrollment among patients who were women and at earlier WHO clinical stages. Retention and mortality outcomes at 6 and 12 months generally improved over the 11 year follow-up period, though dipped as enrollment in asymptomatic disease stage increased.
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Affiliation(s)
- P Wekesa
- Centre for Health Solutions - Kenya, Nairobi, Kenya.
| | - A McLigeyo
- Centre for Health Solutions - Kenya, Nairobi, Kenya.
| | - K Owuor
- Centre for Health Solutions - Kenya, Nairobi, Kenya
| | - J Mwangi
- Division of Global HIV & TB, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - L Isavwa
- Centre for Health Solutions - Kenya, Nairobi, Kenya
| | - A Katana
- Division of Global HIV & TB, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
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24
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Nacarapa E, Verdu ME, Nacarapa J, Macuacua A, Chongo B, Osorio D, Munyangaju I, Mugabe D, Paredes R, Chamarro A, Revollo B, Alexandre SS, Simango M, Torrus D, Ramos-Rincon JM. Predictors of attrition among adults in a rural HIV clinic in southern Mozambique: 18-year retrospective study. Sci Rep 2021; 11:17897. [PMID: 34504234 PMCID: PMC8429703 DOI: 10.1038/s41598-021-97466-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/18/2021] [Indexed: 11/09/2022] Open
Abstract
HIV remains a major cause of morbidity and mortality for people living in many low-income countries. With an HIV prevalence of 12.4% among people aged over 15 years, Mozambique was ranked in 2019 as one of eight countries with the highest HIV rates in the world. We analyzed routinely collected data from electronical medical records in HIV-infected patients aged 15 years or older and enrolled at Carmelo Hospital of Chokwe in Chokwe from 2002 to 2019. Attrition was defined as individuals who were either reported dead or lost to follow-up (LTFU) (≥ 90 days since the last clinic visit with missed medical pick-up after 3 days of failed calls). Kaplan–Meier survival curves and Cox regression analyses were used to model the incidence and predictors of time to attrition. From January 2002 to December 2019, 16,321 patients were enrolled on antiretroviral therapy (ART): 59.2% were women, and 37.9% were aged 25–34 years old. At the time of the analysis, 7279 (44.6%) were active and on ART. Overall, the 16,321 adults on ART contributed a total of 72,987 person-years of observation. The overall attrition rate was 9.46 per 100 person-years. Cox regression showed a higher risk of attrition in those following an inpatient regimen (hazard ratio [HR] 3.18, 95% confidence interval [CI] 2.89–3.50; p < 0.001), having CD4 counts under 50 cells/µL (HR 1.91, 95% CI 1.63–2.24, p < 0.001), receiving anti-TB treatment within 90 days of ART initiation (HR 6.53, 95% CI 5.72–7.45; p < 0.001), classified as WHO clinical stage III (HR 3.75, 95% CI 3.21–4.37; p < 0.001), and having Kaposi’s sarcoma (HR 1.99, 95% CI 1.65–2.39, p < 0.001). Kaplan–Meier analysis showed that patients with CD4 counts of less than 50 cells/µL on ART initiation had a 40% lower chance of survival at 18 years. Low CD4 cell counts, ART initiation as an inpatient, WHO clinical stage III, and anti-tuberculosis treatment within 90 days of ART initiation were strongly associated with attrition. Strengthening HIV testing and ART treatment, improving the diagnosis of tuberculosis before ART initiation, and guaranteed psychosocial support systems are the best tools to reduce patient attrition after starting ART.
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Affiliation(s)
- Edy Nacarapa
- Carmelo Hospital of Chókwè - The Daughters of Charity, Saint Vicente of Paul, TB/HIV Division, Avenida Trabalho, Chokwé, Gaza Province, Mozambique.,Tinpswalo Association, Vincentian Association to Fight AIDS and TB, Research Unit, Chókwè, Gaza Province, Mozambique
| | - M Elisa Verdu
- Carmelo Hospital of Chókwè - The Daughters of Charity, Saint Vicente of Paul, TB/HIV Division, Avenida Trabalho, Chokwé, Gaza Province, Mozambique
| | - Joana Nacarapa
- Carmelo Hospital of Chókwè - The Daughters of Charity, Saint Vicente of Paul, TB/HIV Division, Avenida Trabalho, Chokwé, Gaza Province, Mozambique.,Tinpswalo Association, Vincentian Association to Fight AIDS and TB, Research Unit, Chókwè, Gaza Province, Mozambique
| | - Artur Macuacua
- Carmelo Hospital of Chókwè - The Daughters of Charity, Saint Vicente of Paul, TB/HIV Division, Avenida Trabalho, Chokwé, Gaza Province, Mozambique
| | - Bartolomeu Chongo
- Carmelo Hospital of Chókwè - The Daughters of Charity, Saint Vicente of Paul, TB/HIV Division, Avenida Trabalho, Chokwé, Gaza Province, Mozambique
| | | | - Isabelle Munyangaju
- Tinpswalo Association, Vincentian Association to Fight AIDS and TB, Research Unit, Chókwè, Gaza Province, Mozambique
| | | | - Roger Paredes
- IrsiCaixa - Institute of AIDS Research, Barcelona, Spain.,FLS Foundation - Fight AIDS Foundation, Barcelona, Spain
| | - Ana Chamarro
- FLS Foundation - Fight AIDS Foundation, Barcelona, Spain
| | - Boris Revollo
- FLS Foundation - Fight AIDS Foundation, Barcelona, Spain
| | | | | | - Diego Torrus
- Department of Internal Medicine, University General Hospital of Alicante and Miguel Hernandez University, Elche, Spain
| | - Jose-Manuel Ramos-Rincon
- Department of Internal Medicine, University General Hospital of Alicante and Miguel Hernandez University, Elche, Spain.
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25
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Elgalib A, Shah S, Al-Wahaibi A, Al-Habsi Z, Al-Fouri M, Lau R, Al-Kindi H, Al-Rawahi B, Al-Abri S. Retention in HIV care and factors associated with loss to follow-up in Oman: a countrywide study from the Middle East. AIDS Care 2021; 34:568-574. [PMID: 33910425 DOI: 10.1080/09540121.2021.1916871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We conducted a cross-sectional analysis to determine the rate of retention in HIV care and the factors associated with loss to follow-up (LTFU) among Omani adults living with HIV who were linked to care as of 31 December 2019. Patients (n = 1610) were identified from a central national HIV surveillance dataset. The majority (68.3%) of patients were male, and the median age was 39 years (IQR, 31-48 years). A total of 1480 patient (91.9%) were retained in care. On multivariate analysis, compared to those who received antiretroviral therapy (ART), patients who had never been on ART were 6.8 (95% CI: 3.05-15.16) times more likely to be lost to follow-up. Patients who had a latest HIV viral load (VL) of 200-999 copies/ml (adjusted odds ratio [aOR]: 4.92, 95% CI: 2.27-10.69) and ≥ 1000 copies/ml (aOR: 15.03, 95% CI: 8.31-27.19) compared to those who had a latest HIV VL of <200 copies/ml had higher odds of loss to follow-up. Moreover, patients who were divorced or widowed were 2.64 (95% CI: 1.14-6.07) times more likely to disengage from HIV services, compared to those who were married. These findings will be invaluable in developing targeted interventions that further improve patients' retention in HIV care in Oman.
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Affiliation(s)
- Ali Elgalib
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Samir Shah
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Adil Al-Wahaibi
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Zeyana Al-Habsi
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Maha Al-Fouri
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Richard Lau
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Hanan Al-Kindi
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Bader Al-Rawahi
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
| | - Seif Al-Abri
- Directorate General for Disease Surveillance and Control, Ministry of Health, Muscat, Oman
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