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da Silva ASP, Amianti C, Bandeira LM, Júnior RB, Faccin GM, Motta-Castro ARC. Tracking People Living with HIV in Loss to Follow Up in Central Brazil: A Call for Attention to Health Services. AIDS Behav 2024; 28:2403-2409. [PMID: 38720109 DOI: 10.1007/s10461-024-04337-8] [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] [Accepted: 03/27/2024] [Indexed: 06/26/2024]
Abstract
Despite the effectiveness of antiretroviral therapy (ART), human immunodeficiency virus (HIV) infection remains a global public health concern. However, weaknesses in its management regarding access to integrated HIV care include treatment gaps and loss to follow-up (LTFU) from antiretroviral treatment (ART). This study aimed to characterize the epidemiological and clinical profiles of people living with HIV/AIDS (PLHA) in LTFU from HIV care in Campo Grande, Central Brazil. This retrospective cross-sectional study was conducted between January 2021 and April 2022 using secondary data from PLHA who had LTFU in Campo Grande. A total of 852 patients with PLHA were included in this study. The majority of participants in LTFU were male (63.1%), had a CD4 cell count > 200 cells/mm3 (68.2%), and had been treated for ≥ 3 months (86.4%). Only 287 (33.7%) participants had undetectable HIV viral load. Of the total number of patients who returned to treatment during the study period, 448 (54.3%) were LTFU-positive. The tracking strategy was not applied to 556 (65.26%) patients, and 44.4% of the participants had been in spontaneous demand. These results highlight the relevance of patient-centered interventions and the need to ensure early treatment and promote retention in care systems with consequent viral suppression, impacting the healthcare indicators of the population, with emphasis on health managers and stakeholders in HIV care.
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Affiliation(s)
| | - Carolina Amianti
- Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil.
| | | | - Roberto Braz Júnior
- Secretaria Municipal de Saúde de Campo Grande (SESAU), Campo Grande, MS, Brazil
| | | | - Ana Rita Coimbra Motta-Castro
- Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil
- Fiocruz Mato Grosso do Sul, Fundação Oswaldo Cruz/Ministério da Saúde, Campo Grande, Brazil
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Anulo A, Girma A, Tesfaye G, Asefa F, Cheru A, Lonsako AA. Incidence and predictors of loss to follow-up among adult patients receiving antiretroviral therapy in Central Ethiopia: a multi-center retrospective cohort study. Front Public Health 2024; 12:1374515. [PMID: 38544723 PMCID: PMC10965614 DOI: 10.3389/fpubh.2024.1374515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/22/2024] [Indexed: 05/16/2024] Open
Abstract
Background Globally, loss to follow-up (LTFU) remains a significant public health concern despite the rapid expansion of antiretroviral medication programs. It is a significant cause of treatment failure and threatens the enhancement of HIV treatment outcomes among patients on antiretroviral therapy (ART). However, there is a paucity of evidence on its incidence and predictors in Ethiopia. Thus, this study aimed to examine the incidence and predictors of LTFU among adult HIV patients receiving ART at hospitals in Central Ethiopia. Methods A multi-centered facility-based retrospective cohort study was conducted among 432 randomly selected adult patients who received antiretroviral therapy. Data were entered into EpiData version 3.1 and exported to Stata version 14 for analysis. The Kaplan-Meier failure function was employed to determine the overall failure estimates, and the log-rank test was used to compare the probability of failure among the different categories of variables. The Cox proportional hazard model was used to identify independent predictors of LTFU. Results Overall, 172 (39.8%) study participants were lost to follow-up over the 10-year follow-up period with an incidence rate of 8.12 (95% CI: 7.11, 9.09) per 1,000 person-months. Undisclosed HIV status (AHR: 1.96, 95% CI: 1.14, 3.36), not able to work (AHR: 1.84, 95% CI: 1.13, 2.22), opportunistic infections (AHR: 3.13, 95% CI: 2.17, 4.52), CD4 < 200 cell/mL (AHR: 1.95, 95% CI: 1.18, 3.21), not receiving isoniazid preventive therapy (IPT) (AHR: 2.57, 95% CI: 1.62, 4.06), not participating in clubs (AHR: 1.68, 95% CI: 1.10, 2.22), side effects of drugs (AHR: 1.44, 95% CI: 1.02, 2.04), and high viral load (AHR: 3.15, 95% CI: 1.81, 5.47) were identified as significant predictors of loss to follow-up. Conclusion In this study, the incidence of LTFU was high. The focus should be on creating awareness and prevention programs that aim to reduce loss to follow-up by continuing counseling, especially on the negative effects of loss to follow-up and the benefits of ART care.
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Affiliation(s)
- Asfaw Anulo
- Dr Bogalech Gebre Memorial General Hospital, Durame, Ethiopia
| | - Addisu Girma
- Dr Bogalech Gebre Memorial General Hospital, Durame, Ethiopia
| | - Gezahegn Tesfaye
- College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Fekede Asefa
- Department of Pediatrics, The University of Tennessee Health Science Center (UTHSC) – Oak Ridge National Laboratory (ORNL) Center for Biomedical Informatics, Memphis, TN, United States
| | - Abera Cheru
- School of Environmental Health Science, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Arega Abebe Lonsako
- College of Medicine and Health Science, Arba Minch University, Arba Minch, Ethiopia
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Tassembédo S, Traoré IT, Traoré-Barro M, Diallo I, Maré D, Diallo-Barry F, Rajaonarivelo C, Coulibaly B, Nikiema A, Poda A, Vande Perre P, Nagot N. Using adult care visits to diagnose HIV infection in children, Burkina Faso. Bull World Health Organ 2024; 102:187-195. [PMID: 38420571 PMCID: PMC10898281 DOI: 10.2471/blt.23.289606] [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: 01/02/2023] [Revised: 10/24/2023] [Accepted: 11/30/2023] [Indexed: 03/02/2024] Open
Abstract
Objective To estimate the feasibility, positivity rate and cost of offering child testing for human immunodeficiency virus (HIV) to mothers living with HIV attending outpatient clinics in Burkina Faso. Methods We conducted this implementation study in nine outpatient clinics between October 2021 and June 2022. We identified all women ≤ 45 years who were attending these clinics for their routine HIV care and who had at least one living child aged between 18 months and 5 years whose HIV status was not known. We offered these mothers an HIV test for their child at their next outpatient visit. We calculated intervention uptake, HIV positivity rate and costs. Findings Of 799 eligible children, we tested 663 (83.0%) and identified 16 new HIV infections: 2.5% (95% confidence interval, CI: 1.5-4.1). Compared with HIV-negative children, significantly more HIV-infected children were breastfed beyond 12 months (P-value: 0.003) and they had not been tested before (P-value: 0.003). A significantly greater proportion of mothers of HIV-infected children were unaware of the availability of child testing at 18 months (P-value: < 0.001) and had more recently learnt their HIV status (P-value: 0.01) than mothers of HIV-negative children. The intervention cost 98.1 United States dollars for one child testing HIV-positive. Barriers to implementing this strategy included shortages of HIV tests, increased workload for health-care workers and difficulty accessing children not living with their mothers. Conclusion Testing HIV-exposed children through their mothers in outpatient clinics is feasible and effective in a low HIV-prevalence setting such as Burkina Faso. Implementation of this strategy to detect undiagnosed HIV-infected children is recommended.
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Affiliation(s)
- Souleymane Tassembédo
- Centre Muraz, Institut National de Santé Publique, Bobo-Dioulassso, Programme de Recherche sur les Maladies Infectieuses, Centre Muraz 2054 Avenue Mamadou Konate, Bobo-Dioulasso, Burkina Faso
| | | | - Makoura Traoré-Barro
- Institut Supérieur des Sciences de la Santé, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso
| | - Ismael Diallo
- Département de Médecine, Centre Hospitalier Universitaire Yalgado Ouedraogo, Ouagadougou, Burkina Faso
| | | | - Fatimata Diallo-Barry
- Centre Médical avec Antenne Chirurgicale de Pissy, Direction Régionale de la Santé du Centre, Ouagadougou, Burkina Faso
| | | | - Bethem Coulibaly
- Centre Médical avec Antenne Chirurgicale de Dafra, Direction Régionale de la Santé des Hauts-Bassins, Bobo-Dioulasso, Burkina Faso
| | - Amélie Nikiema
- Centre Médical avec Antenne Chirurgicale de Do, Direction Régionale de la Santé des Hauts-Bassins, Bobo-Dioulasso, Burkina Faso
| | - Armel Poda
- Département de Médecine, Centre Hospitalier Universitaire Souro Sanou, Bobo-Dioulasso, Burkina Faso
| | - Philippe Vande Perre
- Pathogenesis and Control of Chronic and Emerging Infections, Montpellier University, Institut national de la santé et de la recherche médicale (INSERM), Montpellier, France
| | - Nicolas Nagot
- Pathogenesis and Control of Chronic and Emerging Infections, Montpellier University, Institut national de la santé et de la recherche médicale (INSERM), Montpellier, France
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Tugume L, Semitala FC, Owachi D, Kagimu E, Kamya MR, Meya DB. Clinical characteristics and morbidity among hospitalized adults with advanced HIV disease in Uganda during 'test and treat' era. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002457. [PMID: 37851597 PMCID: PMC10584089 DOI: 10.1371/journal.pgph.0002457] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/13/2023] [Indexed: 10/20/2023]
Abstract
Nearly four decades after the first case of AIDS was described, the global number of AIDS-related deaths has steadily declined but falls short of the elimination targets, especially in sub-Saharan Africa. Despite interventions to promote early HIV diagnosis and treatment, hospitalization and mortality related to advanced HIV disease (AHD) remains a significant public health problem in Uganda. We assessed the HIV treatment history and causes of hospitalization among in-patients with AHD at a tertiary hospital in Uganda. In this cross-sectional study, pre-hospitalization HIV treatment history and clinical characteristics of HIV-positive in-patients with CD4<200 cells/μL or WHO stage 3 or 4 clinical events were assessed. Descriptive data were summarized using percentages and medians. Among hospitalized adults with AHD from November 2021 to June 2022, 74% (260/353) knew their HIV status prior to hospitalization and 62% (219/353) were ART experienced at presentation. The median time since ART initiation was 28 months (IQR; 2-97). Overall, 73% (258/353) had at least two etiological diagnoses and the majority (non-mutually exclusive) were diagnosed with tuberculosis (61.2%), cryptococcal meningitis (20.7%), mucosal candidiasis (16.1%) and bacterial infections (15%). In conclusion, nearly two-thirds of in-patients with advanced HIV disease were ART experienced prior to hospitalization and tuberculosis was the most common cause of hospitalization. Innovative strategies to strengthen HIV diagnosis, linkage, and retention in HIV care and to increase coverage of TB preventive therapy are urgently needed.
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Affiliation(s)
- Lillian Tugume
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fred C. Semitala
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Kiruddu National Referral Hospital, Kampala, Uganda
- Makerere University Joint AIDS Program, Kampala, Uganda
| | | | - Enock Kagimu
- Department of Research, Infectious Diseases Institute Makerere University, Kampala, Uganda
| | - Moses R. Kamya
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - David B. Meya
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Research, Infectious Diseases Institute Makerere University, Kampala, Uganda
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Zeleke S, Demis S, Eshetie Y, Kefale D, Tesfahun Y, Munye T, Kassaw A. Incidence and Predictors of Loss to Follow-Up Among Adults on Antiretroviral Therapy in South Gondar Governmental Hospitals, Ethiopia: Retrospective Cohort Study. J Multidiscip Healthc 2023; 16:1737-1748. [PMID: 37377665 PMCID: PMC10292207 DOI: 10.2147/jmdh.s414194] [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: 04/17/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
Background Approximately 38.4 million adult people worldwide live with HIV, of which the majority live in Africa. In Ethiopia increasing the quality of life to HIV patients and preventing HIV transmission are challenging. Even though test-and-treat strategy is applied for early enrollment to ART, poor retention and loss to follow-up are hindering the care. Objective This study examined the incidence and predictors of loss to follow-up among adult HIV patients on ART in South Gondar governmental hospitals, September 11, 2017-September 10, 2022. Methods A multi-facility-based retrospective follow-up study was conducted. Study subjects were assigned using simple random sampling methods by their medical record numbers. The data were entered into EPI data version 3.0.2 and exported to STATA version 17 for analysis. The Kaplan-Meier failure function was employed to determine the overall failure estimates. Cox proportional hazard model was tailored for both bi-variable and multivariable. Variables at p-value <0.05 with 95% CI were significantly associated with loss to follow-up. Results In this study, about 559 adult HIV survivors were included, and the response rate was 98%. The mean age and standard deviation (±SD) of study subjects were 36.6±9.3 years. The incidence rate of loss to follow-up was 6.7 per 100 person-years (95% CI: 5.6, 8.1). Educational status [AHR: 1.68 (95% CI: 1.04, 2.72)], substance use [AHR: 2.38 (95% CI: 1.50, 3.75)], and ART adherence [AHR: 3.33 (95% CI: 1.38, 8.08)] were significant determinants to loss to follow-up. Conclusion In conclusion, the study finding reported that the incidence of loss to follow-up was low. HIV patients who did not have formal education, substance users, and poor ART adherence were at greater hazard of being lost to follow-up. In order to mitigate the rate of loss to follow-up, it is recommended to strengthen the available intervention modalities.
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Affiliation(s)
- Shegaw Zeleke
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Solomon Demis
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yeshiambaw Eshetie
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoz Kefale
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yohannes Tesfahun
- Department of Emergency and Critical Care Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tigabu Munye
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Kassaw
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Predictors of Loss to Follow-Up among HIV-Infected Adults after Initiation of the First-Line Antiretroviral Therapy at Arba Minch General Hospital, Southern Ethiopia: A 5-Year Retrospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8659372. [PMID: 34805406 PMCID: PMC8601861 DOI: 10.1155/2021/8659372] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/25/2021] [Accepted: 10/30/2021] [Indexed: 12/02/2022]
Abstract
Background Loss to follow-up (LTFU) from antiretroviral therapy (ART) reduces treatment benefits and leads to treatment failure. Hence, this study was aimed at determining the incidence of loss to follow-up and predictors among HIV-infected adults who began first-line antiretroviral therapy at Arba Minch General Hospital. Methods We carried out an institutional-based retrospective cohort study, and data were collected from the charts of 508 patients who were selected using a simple random sampling technique. All the data management and statistical analyses were conducted using STATA version 14. Cumulative survival probability was estimated and presented in the life table, and the Kaplan-Meir survival curves were compared using the log-rank test. The Cox proportional hazard model was used to identify the independent predictors. Results We followed 508 patients for 871.9 person-years. A total of 46 (9.1%) experienced loss to follow-up, yielding an overall incidence rate of 5.3 (95% CI: 3.9-7.1) per 100 person-years. The cumulative survival probability was 90%, 88%, 86%, and 86% at the end of one, two, three, and four years, respectively. The predictors identified were age less than 35 years (adjusted hazard ratio (aHR = 1.96; 95% CI: 1.92-4.00)), rural residence (aHR = 1.98; 95% CI: 1.02-3.83), baseline body weight greater than 60 kilograms (aHR = 2.19; 95% CI: 1.11-4.37), a fair level of adherence (aHR = 11.5; 95% CI: 2.10-61.10), and a poor level of adherence (aHR = 12.03; 95% CI: 5.4-26.7). Conclusions In this study, the incidence rate of loss to follow-up was low. Younger adults below the age of 35 years, living in rural areas, with a baseline weight greater than 60 kilograms, which had a fair and poor adherence level were more likely to be lost from treatment. Therefore, health professionals working in ART clinics and potential stakeholders in HIV/AIDS care and treatment should consider adult patients with these characteristics to prevent LTFU.
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