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Alemu GG, Tesfie TK, Abuhay HW, Mengistu B, Awoke G, Kefale GT, Beyene MM, Nibret M. Incidence of loss to follow-up and its predictors among HIV-infected under-five children after initiation of antiretroviral therapy in West Amhara Comprehensive Specialized Referral Hospitals, Northwest Ethiopia: a multicenter retrospective follow-up study. BMC Pediatr 2024; 24:615. [PMID: 39342164 PMCID: PMC11438255 DOI: 10.1186/s12887-024-05086-2] [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: 12/04/2023] [Accepted: 09/18/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Loss to follow-up (LTFU) among under-five children from HIV care profoundly affects the treatment outcomes of this vulnerable population. It is a major factor that negatively affects the benefits of antiretroviral therapy (ART). Current information about LTFU among HIV-positive under-five children on ART is essential for effective treatments. To far, nevertheless, limited research has been done in Ethiopia to address this issue. Thus, this study aimed to assess the incidence and predictors of LTFU among HIV-infected under-five children receiving ART in West Amhara Comprehensive Specialized Referral Hospitals. METHODS A multicenter institution-based retrospective follow-up study was conducted among 435 HIV-infected under-five children on ART selected by simple random sampling from January 1, 2010 to December 31, 2019, and data were collected between December 1, 2021, and January 31, 2022. A standardized data extraction tool adapted from the ART entry and follow-up forms was used. The event of interest for this study was LTFU, whereas the absence of LTFU was censored. Before being transferred to STATA version 14 for analysis, the data were entered into Epi-Data version 3.1. The Kaplan‒Meier curve was used to estimate an individual's survival-free probability at each specific point in time. The Cox proportional hazards model was used to identify predictors of LTFU. RESULTS Among the 420 records included in the final analysis, 30 (7.14%) of the individuals were LTFUs. The incidence rate of LTFU was 3.4 per 1000 person-months of observation (95% CI: 2.43-4.87). The survival probabilities of children after 12, 24, 36, and 48 months were 0.97, 0.92, 0.88, and 0.77, respectively. The independent predictors of LTFU were HIV infection in under-five children who lived in rural areas (AHR = 3.64; 95% CI: 1.41, 9.37), poor adherence to ART (AHR = 4.37; 95% CI: 1.59, 12.02), not receiving cotrimoxazole preventive therapy (AHR = 3.75; 95% CI: 1.39, 10.08), not receiving isoniazid prophylaxis (AHR = 3.4; 95% CI: 1.29, 9.01), and having a severe WHO clinical stage (AHR = 5.43; 95% CI: 1.38, 11.43). CONCLUSION AND RECOMMENDATION The incidence of loss to follow-up was high, especially in the first two years after ART initiation. The risk of LTFU was greater for those who were rural residents, had poor adherence, lacked cotrimoxazole preventive therapy, not given isoniazid prophylaxis, and presented with WHO clinical stages III and IV. Therefore, clinicians should emphasize for cotrimoxazole preventive therapy and isoniazid prophylaxis, for those living in rural areas, who present with poor adherence and WHO clinical stages III and IV.
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Affiliation(s)
- Gebrie Getu Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Po. Box 196, Gondar, Ethiopia.
| | - Tigabu Kidie Tesfie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Po. Box 196, Gondar, Ethiopia
| | - Habtamu Wagnew Abuhay
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Po. Box 196, Gondar, Ethiopia
| | - Berhanu Mengistu
- Department of Human Nutrition, University of Gondar, Gondar, Ethiopia
| | - Getaneh Awoke
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Po. Box 196, Gondar, Ethiopia
| | - Getachew Teshale Kefale
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Mekuriaw Nibret
- Department of Human Nutrition, University of Gondar, Gondar, Ethiopia
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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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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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Gemechu A, Mihret A, Aseffa A, Howe R, Seyoum B, Mulu A. Loss to Follow-up and Death Among Individuals With Newly Diagnosed Human Immunodeficiency Virus Receiving Dolutegravir-Based First-Line Antiretroviral Treatment in Eastern Ethiopia: Implications for 95% United Nations Targets. Open Forum Infect Dis 2023; 10:ofad522. [PMID: 37953815 PMCID: PMC10638489 DOI: 10.1093/ofid/ofad522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/18/2023] [Indexed: 11/14/2023] Open
Abstract
Background Loss to follow-up (LTFU) and death are unfavorable outcomes of human immunodeficiency virus (HIV) treatment. This study aimed to identify the predictors of LTFU and death among individuals with newly diagnosed HIV receiving dolutegravir (DTG)-based first-line antiretroviral treatment (ART) in eastern Ethiopia. Methods A multisite prospective cohort study was carried out between October 2020 and July 2022. New case patients who started ART were enrolled consecutively and then followed up for the next 6 months. A structured questionnaire and checklists were used to collect data. HIV viral load was determined using the Abbott RealTime HIV-1 assay. Bivariable and multivariable logistic regression models were used to identify baseline factors associated with the outcomes. Results A total of 235 people with newly diagnosed HIV were enrolled; 16.6% (95% confidence interval, 12.3%-21.9%) were lost to follow-up, and 5.9% (3.5%-9.8%) died within 6 months of follow-up. Baseline World Health Organization clinical stage I (adjusted odds ratio, 3.93 [95% confidence interval, 1.34-11.57]), low viral load (3.67 [1.09-12.36]), and body weight (1.04 [1.01-1.07]) were predictors of LTFU, whereas nonfunctional status (10.02 [1.9-51.3]) was the only factor associated with death. Conclusions LTFU and death rates among patients with DTG were relatively high, accounting for roughly a quarter of the attrition of people with newly diagnosed HIV from ART care and services. Thus, targeted interventions are required to reduce LTFU and death among individuals with HIV on ART. Further investigation is necessary to evaluate the long-term effects of DTG-based regimens on LTFU and its impact on HIV mortality rates, and qualitative research, specifically tracing LTFU, is recommended.
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Affiliation(s)
- Abdella Gemechu
- School of Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Adane Mihret
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Rawleigh Howe
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Berhanu Seyoum
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
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Kassa S, Dingeta T, Gobana T, Dufera T. Incidence and predictors of attrition among adults receiving first line anti-retroviral therapy at public health facility in Adea Berga district, Oromia, Ethiopia. J Public Health Res 2023; 12:22799036231197194. [PMID: 37693738 PMCID: PMC10492486 DOI: 10.1177/22799036231197194] [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: 02/13/2023] [Accepted: 07/30/2023] [Indexed: 09/12/2023] Open
Abstract
Background According to current estimates, there are 665,723 people in Ethiopia who have human immunodeficiency syndrome. As Ethiopia inches closer to attaining the 95/95/95 targets for treatment coverage and reaching epidemic control, however, attrition from anti-retroviral treatment is still one of the key programmatic challenges. Objective To assess the incidence of attrition rate and its predictors among adult HIV patients receiving anti retro viral treatment at Public Health Facility in Adea Berga/Enchini District. Method A 6-year (June 28, 2015 to June 27, 2021) institution-based retrospective cohort study was used to recruit 540 study participants by using simple random sampling. Data were obtained from chart review, coded, entered into Epi Data, and exported to Stata 14.2 software for analysis. At least 1 month missed appointment is considered as attrition and the predictors of attrition were identified using bivariable and multivariable Cox proportional hazard models and an adjusted hazard ratio (AHR). Bivariate and multivariate analyses were conducted to find predictors of attrition, p-value < 0.05 was considered statistically significant. Results From the total 540 study participant, 158 (29.26%) patients were discontinuing from follow up making the incidence rate of attrition 9.50 per 100 person years .Being WHO clinical stage III or IV (AHR = 1.96,), non-practice of Appointment spacing model (AHR = 3.98), poor or fair ART adherence level (AHR = 6.47), age groups (15-24) years (AHR = 1.73) and Others ART linkage points[index case testing, tuberculosis clinic and referral from private/public health institutions] (AHR = 1.76) were significantly associated. Conclusions The study showed that the incidence of attrition among adults receiving antiretroviral therapy was high. Patient sociodemographic, clinical, and treatment-related factors were significantly associated with patients on ART.
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Affiliation(s)
- Seifu Kassa
- Boloso Bombe District Health Office, South Ethiopia Regional State, Addis Ababa, Ethiopia
| | - Tariku Dingeta
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tesfaye Gobana
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tadesse Dufera
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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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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Salih AM, Yazie TS, Gulente TM. Survival analysis and predictors of mortality among adult HIV/AIDS patients initiated antiretroviral therapy from 2010 to 2015 in Dubti General Hospital, Afar, Ethiopia: A retrospective cohort study. Heliyon 2023; 9:e12840. [PMID: 36685372 PMCID: PMC9850048 DOI: 10.1016/j.heliyon.2023.e12840] [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: 08/27/2021] [Revised: 12/31/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023] Open
Abstract
Background Although antiretroviral therapy (ART) is well accepted to increase survival of patients with HIV/AIDS, AIDS related deaths continue to be a major problem in sub-Saharan Africa like Ethiopia. Studies have showed variable findings in the survival status of patients with HIV/AIDS initiating ART, and there was no such study in the study area. Therefore, purpose of this study was to determine the survival and predictors of mortality among HIV/AIDS patients starting taking ART in Dubti General Hospital, Afar, Ethiopia. Methods A 5 year retrospective cohort study was performed among 702 HIV/AIDS patients aged ≥15 years that started ART between December 31, 2010, and December 31, 2015 in Dubti General Hospital, Afar, Ethiopia. A simple random sampling technique was used to select the study subjects from each WHO stage based stratum. Socio-demographic, clinical and survival status data were extracted by reviewing patients' records. Data were analyzed by using SPSS Version 21. Kaplan-Meier and Cox-regression models were used to estimate survival, and explore predictors of mortality. Variables with a p value of <0.05 in multivariate Cox regression analysis were considered statistically significant. Results Among 702 study participants, 82 (11.7%) died during follow up, and the overall incidence rate of mortality was 5.81 per 100 person-years. Identified predictors of mortality were being not married (AHR = 3.71, 95% CI: 1.97-6.99), had no formal education (AHR = 2.33, 95% CI: 1.33-4.38), bedridden functional status (AHR = 5.91, 95% CI: 2.71-12.88), advanced WHO stage III and IV (AHR = 4.36, 95% CI: 2.20-8.64), BMI 16-18.4 kg/m2 (AHR = 3.03, 95% CI: 1.50-6.13), and BMI<16.0 kg/m2 (AHR = 5.47; 95% CI: 2.85-10.50), CD4 count ≤50 cells/mm3 (AHR = 6.62, 95% CI: 4.73-8.52), hemoglobin <8 g/dl (AHR = 5.21; 95% CI: 2.64-10.26), not used cotrimoxazole prophylaxis therapy (AHR = 2.78, 95% CI: 1.61-4.73), stavudine based regimen (AHR = 2.34, 95% CI: 1.32-4.13), and zidovudine based regimen (AHR = 2.49, 95% CI: 1.41-4.39). Conclusion High mortality was observed in this cohort, and participants with stage III and IV, low CD4 count, low hemoglobin level, bed ridden functional status, low BMI should be closely monitored even with the scarce resources. In addition, the use of cotrimoxazole prophylaxis therapy should be more encouraged to increase survival.
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Affiliation(s)
| | - Taklo Simeneh Yazie
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Tabor University, P.O.Box 272, Debre Tabor, Amhara, Ethiopia,Corresponding author.
| | - Tesfaye Molla Gulente
- Curative and Rehabilitative Department, Afar National Regional State Health Bureau, Afar, Ethiopia
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Akpan U, Kakanfo K, Ekele OD, Ukpong K, Toyo O, Nwaokoro P, James E, Pandey S, Olatubosun K, Bateganya M. Predictors of treatment interruption among patients on antiretroviral therapy in Akwa Ibom, Nigeria: outcomes after 12 months. AIDS Care 2023; 35:114-122. [PMID: 35765160 DOI: 10.1080/09540121.2022.2093826] [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: 10/17/2022]
Abstract
Understanding the characteristics of people living with HIV who interrupt antiretroviral therapy (ART) is critical for designing client-centered services to ensure optimal outcomes. We assessed predictors of treatment interruption in 22 HIV clinics in Nigeria. We reviewed records of HIV-positive patients aged ≥15 years who started ART 1 January and 31 March 2019. We determined treatment status over 12 months as either active, or interrupted treatment (defined as interruption in treatment up to 28 days or longer). Potential predictors were assessed using Cox hazard regression models. Overall, 1185 patients were enrolled on ART, 829 (70%) were female, and median age was 32 years. Retention at 1, 3, 6, 9, and 12 months was 85%, 80%, 76%, 72%, and 68%, respectively. Predictors of treatment interruption were post-secondary education (p = 0.04), diagnosis through voluntary counseling and testing (p < 0.001), receiving care at low-volume facilities (p < 0.001), lack of access to a peer counselor (p < 0.001), and residing outside the clinic catchment area (p = 0.03). Treatment interruption was common but can be improved by focusing on lower volume health facilities, providing peer support especially to those with higher education, and client-centered HIV services for those who live further from clinics..
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Affiliation(s)
- Uduak Akpan
- Achieving Health Nigeria Initiative, Akwa Ibom, Nigeria
| | | | - Oche D Ekele
- Achieving Health Nigeria Initiative, Akwa Ibom, Nigeria
| | - Kufre Ukpong
- Achieving Health Nigeria Initiative, Akwa Ibom, Nigeria
| | - Otoyo Toyo
- Achieving Health Nigeria Initiative, Akwa Ibom, Nigeria
| | | | - Ezekiel James
- United States Agency for International Development, Abuja, Nigeria
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Niu D, Tang H, Chen F, Zhao D, Zhao H, Hou Y, Wang S, Lyu F. Treatment failure and associated factors among people living with HIV on highly active antiretroviral therapy in mainland China: A systematic review and meta-analysis. PLoS One 2023; 18:e0284405. [PMID: 37130123 PMCID: PMC10153698 DOI: 10.1371/journal.pone.0284405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/30/2023] [Indexed: 05/03/2023] Open
Abstract
OBJECTIVE Reducing the prevalence of treatment failure among people living with HIV (PLHIV) on highly active antiretroviral therapy (HAART) is crucial for improving individual health and reducing disease burden. This study aimed to assess existing evidence on treatment failure and its associated factors among PLHIV in mainland China. METHODS We conducted a comprehensive search of PubMed, Web of Science, Cochrane Library, WanFang, China National Knowledge Infrastructure, and SinoMed databases. Relevant studies on treatment failure among PLHIV in mainland China until September 2022 were searched, including cross-sectional, case-control, and cohort studies. The primary outcome was treatment failure, and secondary outcomes were the potential influencing factors of treatment failure. We performed a meta-analysis to pool each outcome of interest, including meta-regression, subgroup, publication bias, and sensitivity analyses. RESULTS A total of 81 studies were deemed eligible and included in the final meta-analysis. The pooled treatment failure prevalence among PLHIV in mainland China was 14.40% (95% confidence interval [CI]:12.30-16.63), of which the virological and immunological failure prevalence was 10.53% (95%CI:8.51-12.74) and 18.75% (95%CI:15.44-22.06), respectively. The treatment failure prevalence before and after 2016 was 18.96% (95%CI:13.84-24.67) and 13.19% (95%CI:10.91-15.64). Factors associated with treatment failure included good treatment adherence (odds ratio [OR] = 0.36, 95%CI:0.26-0.51), baseline CD4 counts>200 cells/μL (OR = 0.39, 95%CI:0.21-0.75), HAART regimens containing Tenofovir Disoproxil Fumarate (TDF) (OR = 0.70, 95%CI:0.54-0.92), WHO clinical stage III/IV (OR = 2.02, 95%CI:1.14-3.59) and age≥40 years (OR = 1.56, 95%CI:1.23-1.97). CONCLUSION The prevalence of treatment failure among PLHIV receiving HAART in mainland China was low and tended to decline. Poor adherence, low baseline CD4 count, HAART regimens without TDF, advanced clinical stage, and old age were contributing factors for treatment failure. Relevant intervention programs are needed with increasing treatment adherence through behavioral intervention or precise intervention targeting older adults.
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Affiliation(s)
- Dandan Niu
- Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Houlin Tang
- Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fangfang Chen
- Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Decai Zhao
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hehe Zhao
- Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yushan Hou
- Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shi Wang
- Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fan Lyu
- Division of Epidemiology, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Survival rate and predictors of mortality among TB/HIV co-infected adult patients: retrospective cohort study. Sci Rep 2022; 12:18360. [PMID: 36319734 PMCID: PMC9626487 DOI: 10.1038/s41598-022-23316-4] [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: 07/13/2022] [Accepted: 10/29/2022] [Indexed: 12/31/2022] Open
Abstract
Nowadays, Tuberculosis remains the major cause of HIV-associated mortality, which accounts for 1 out of every 5 HIV-related mortality worldwide. This study aimed to determine the survival rate and predictors of mortality among TB/HIV co-infected patients. An institution-based retrospective cohort study was undertaken on adult TB/HIV co-infected individuals between 1st February 2014 and 30th January 2022 at Mettu Karl Referral Hospital. A Cox regression model was used to identify predictors of survival time to death among TB/HIV co-infected patients. This study comprised 402 TB and HIV co-infected adult patients. Among these, 84 (20.9%) died, and 318 (79.1%) were censored. The study subjects have been followed up for 6920 person-months with an overall median survival time of 17.6 months. The overall incidence rate was 12.1 per 1000 person months [95% CI: 9.77-14.98]. The results of a multivariable Cox regression analysis showed that being at an older age, urban residence, WHO clinical stage II & IV, CD4 count of ≥ 200 cells/mm3, bedridden functional status, using INH, and using CPT were associated with the survival time of TB and HIV co-infected patients at a significance level of alpha = 0.05. This retrospective study found that high mortality of TB/HIV co-infected patients occurred in the earlier months of treatment initiation. Close monitoring of patients with low CD4, who do not utilize CPT, who are in advanced WHO stages, and who have poor functional levels can help them improve their health and live longer.
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Bantie B, Seid A, Kerebeh G, Alebel A, Dessie G. Loss to follow-up in "test and treat era" and its predictors among HIV-positive adults receiving ART in Northwest Ethiopia: Institution-based cohort study. Front Public Health 2022; 10:876430. [PMID: 36249247 PMCID: PMC9557930 DOI: 10.3389/fpubh.2022.876430] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 08/29/2022] [Indexed: 01/21/2023] Open
Abstract
Background People living with HIV/AIDS are enrolled in lifelong Anti-Retroviral Treatment (ART) irrespective of their clinical staging as well as CD4 cell count. Although this "Universal Test and Treat" strategy of ART was found to have numerous benefits, loss from follow-up and poor retention remained a long-term challenge for the achievement of ART program targets. Hence, this study is aimed at addressing the much-needed effect of the test and treat strategy on the incidence of loss to follow-up (LTFU) in Ethiopia. Method and materials An institution-based follow-up study was conducted on 513 adults (age ≥15) who enrolled in ART at a public health institution in Bahir Dar City, Northwest Ethiopia. Data were extracted from the charts of selected patients and exported to Stata 14.2 software for analysis. Basic socio-demographic, epidemiological, and clinical characteristics were described. The Kaplan-Meier curve was used to estimate the loss to follow-up free (survival) probability of HIV-positive adults at 6, 12, 24, and 48 months of ART therapy. We fitted a multivariable Cox model to determine the statistically significant predictors of LTFU. Result The incidence density of LTFU was 9.7 per 100 person-years of observation (95% CI: 7.9-11.9 per 100 PYO). Overall, LTFU is higher in the rapid ART initiation (24% in rapid initiated vs. 11.3% in lately initiated, AHR 2.08, P = 0.004), in males (23% males vs. 14.7% females, AHR1.96, P = 0.004), in singles (34% single vs. 11% married, with AHR1.83, P = 0.044), in non-disclosed HIV-status (33% non-disclosed 11% disclosed, AHR 2.00 p = 0.001). Patients with poor/fair ART adherence were also identified as another risk group of LTFU (37% in poor vs. 10.5% in good adherence group, AHR 4.35, P = 0.001). Conclusion The incidence of LTFU in this universal test and treat era was high, and the highest figure was observed in the first 6 months. Immediate initiation of ART in a universal test and treat strategy shall be implemented cautiously to improve patient retention and due attention shall be given to those high-risk patients.
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Affiliation(s)
- Berihun Bantie
- Department of Adult Health Nursing, College of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia,*Correspondence: Berihun Bantie
| | - Awole Seid
- Department of Adult Health Nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gashaw Kerebeh
- Department of Pediatrics and Child Health Nursing, College of Medicine and Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Animut Alebel
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Getenet Dessie
- Department of Adult Health Nursing, School of Health Science, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
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12
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Fentie DT, Kassa GM, Tiruneh SA, Muche AA. Development and validation of a risk prediction model for lost to follow-up among adults on active antiretroviral therapy in Ethiopia: a retrospective follow-up study. BMC Infect Dis 2022; 22:727. [PMID: 36071386 PMCID: PMC9449961 DOI: 10.1186/s12879-022-07691-x] [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: 11/30/2021] [Accepted: 08/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Over 420,000 people have initiated life-saving antiretroviral therapy (ART) in Ethiopia; however, lost-to-follow-up (LTFU) rates continues to be high. A clinical decision tool is needed to identify patients at higher risk for LTFU to provide individualized risk prediction to intervention. Therefore, this study aimed to develop and validate a statistical risk prediction tool that predicts the probability of LTFU among adult clients on ART. Methods A retrospective follow-up study was conducted among 432 clients on ART in Gondar Town, northwest, Ethiopia. Prognostic determinates included in the analysis were determined by multivariable logistic regression. The area under the receiver operating characteristic (AUROC) and calibration plot were used to assess the model discriminative ability and predictive accuracy, respectively. Individual risk prediction for LTFU was determined using both regression formula and score chart rule. Youden index value was used to determine the cut-point for risk classification. The clinical utility of the model was evaluated using decision curve analysis (DCA). Results The incidence of LTFU was 11.19 (95% CI 8.95–13.99) per 100-persons years of observation. Potential prognostic determinants for LTFU were rural residence, not using prophylaxis (either cotrimoxazole or Isoniazid or both), patient on appointment spacing model (ASM), poor drug adherence level, normal Body mass index (BMI), and high viral load (viral copies > 1000 copies/ml). The AUROC was 85.9% (95% CI 82.0–89.6) for the prediction model and the risk score was 81.0% (95% CI 76.7–85.3) which was a good discrimination probability. The maximum sensitivity and specificity of the probability of LTFU using the prediction model were 72.07% and 83.49%, respectively. The calibration plot of the model was good (p-value = 0.350). The DCA indicated that the model provides a higher net benefit following patients based on the risk prediction tool. Conclusion The incidence of LTFU among clients on ART in Gondar town was high (> 3%). The risk prediction model presents an accurate and easily applicable prognostic prediction tool for clients on ART. A prospective follow-up study and external validation of the model is warranted before using the model. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07691-x.
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Affiliation(s)
- Dawit Tefera Fentie
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - Getahun Molla Kassa
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Sofonyas Abebaw Tiruneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Achenef Asmamaw Muche
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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13
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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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14
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van Oorschot E, Koc ÖM, Oude Lashof AML, van Loo IHM, Ackens R, Posthouwer D, Koek GH. Cascade of care among hepatitis B patients in Maastricht, the Netherlands, 1996 to 2018. J Virus Erad 2022; 8:100075. [PMID: 35784678 PMCID: PMC9241047 DOI: 10.1016/j.jve.2022.100075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background & aims Methods Results Conclusions
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Affiliation(s)
- Eva van Oorschot
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Corresponding author. Maastricht UMC+P. Debyelaan 25, 6229, HX, Maastricht, the Netherlands.
| | - Özgür M. Koc
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Gastroenterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Astrid ML. Oude Lashof
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Maastricht University Medical Centre, the Netherlands
| | - Inge HM. van Loo
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, the Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University, the Netherlands
| | - Robin Ackens
- Department of Integrated Care, Maastricht University Medical Centre, the Netherlands
| | - Dirk Posthouwer
- Department of Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Internal Medicine, Division of Infectious Diseases, Maastricht University Medical Centre, the Netherlands
| | - Ger H. Koek
- School of Nutrition and Translational Research in Metabolism (Nutrim), Maastricht University, the Netherlands
- Department of Visceral and Transplantation Surgery, Klinikum, RWTH, Aachen, Germany
- Department of Internal Medicine Division of Gastroenterology and Hepatology, Maastricht University, the Netherlands
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15
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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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16
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Time to lost to follow-up and its predictors among adult patients receiving antiretroviral therapy retrospective follow-up study Amhara Northwest Ethiopia. Sci Rep 2022; 12:2916. [PMID: 35190629 PMCID: PMC8861049 DOI: 10.1038/s41598-022-07049-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/11/2022] [Indexed: 11/08/2022] Open
Abstract
AbstractAntiretroviral therapy lowers viral load only when people living with HIV maintain their treatment retention. Lost to follow-up is the persistent major challenge to the success of ART program in low-resource settings including Ethiopia. The purpose of this study is to estimate time to lost to follow-up and its predictors in antiretroviral therapies amongst adult patients. Among registered HIV patients, 542 samples were included. Data cleaning and analysis were done using Stata/SE version 14 software. In multivariable Cox regression, a p-value < 0.05 at 95% confidence interval with corresponding adjusted hazards ratio (AHR) were statistically significant predictors. In this study, the median time to lost to follow-up is 77 months. The incidence density of lost to follow-up was 13.45 (95% CI: 11.78, 15.34) per 100 person-years. Antiretroviral therapy drug adherence [AHR: 3.04 (95% CI: 2.18, 4.24)], last functional status [AHR: 2.74 (95% CI: 2.04, 3.67)], and INH prophylaxis [AHR: 1.65 (95% CI: 1.07, 2.56) were significant predictors for time to lost to follow-up. The median time to lost was 77 months and incidence of lost to follow-up was high. Health care providers should be focused on HIV counseling and proper case management focused on identified risks.
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17
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Nyakato P, Schomaker M, Fatti G, Tanser F, Euvrard J, Sipambo N, Fox MP, Haas AD, Yiannoutsos CT, Davies MA, Cornell M. Virologic non-suppression and early loss to follow up among pregnant and non-pregnant adolescents aged 15-19 years initiating antiretroviral therapy in South Africa: a retrospective cohort study. J Int AIDS Soc 2022; 25:e25870. [PMID: 35032096 PMCID: PMC8760609 DOI: 10.1002/jia2.25870] [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: 07/13/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Older adolescents aged 15–19 years continue to have high rates of loss to follow up (LTFU), and high rates of virologic non‐suppression (VNS) compared to younger adolescents and adults. Adolescent females are at risk of pregnancy, which puts those living with HIV at a dual vulnerability. Our study assessed the factors associated with VNS and LTFU in older adolescents (including pregnant females) who initiated antiretroviral therapy (ART) in South Africa. Methods We included adolescents aged 15–19 years initiating ART between 2004 and 2019, with ≥ one viral load (VL) measurement between 4 and 24.5 months, and ≥ 6 months follow‐up, from six South African cohorts of the International epidemiology Databases to Evaluate AIDS‐Southern Africa (IeDEA‐SA). We defined VNS as VL ≥400 copies/ml and LTFU as not being in care for ≥180 days from ART start and not known as transferred out of the clinic or dead in the first 24 months on ART. We examined factors associated with VNS and LTFU using Fine&Gray competing risk models. Results We included a total of 2733 adolescents, 415 (15.2%) males, median (IQR) age at ART start of 18.6 (17.3, 19.4) years. Among females, 585/2318 (25.2%) were pregnant. Over the 24‐month follow‐up, 424 (15.5%) of all adolescents experienced VNS: range (11.1% pregnant females and 20.5% males). Over half of all adolescents were LTFU before any other event could occur. The hazard of VNS reduced with increasing age and CD4 count above 200 cells/μl at ART initiation among all adolescents having adjusted for all measured patient characteristics [adjusted sub‐distribution hazard ratio (aSHR) 19 vs. 15 years: 0.50 (95% CI: 0.36, 0.68), aSHR: >500 vs. ≤200 cells/μl: 0.22 (95% CI: 0.16, 0.31)]. The effect of CD4 count persisted in pregnant females. Increasing age and CD4 count >200 cells/μl were risk factors for LTFU among all adolescents. Conclusions Older adolescents had a high risk of LTFU shortly after ART start and a low risk of VNS, especially those initiating treatment during pregnancy. Interventions addressing adherence and retention should be incorporated into adolescent‐friendly services to prevent VNS and LTFU and endeavour to trace lost adolescents as soon as they are identified.
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Affiliation(s)
- Patience Nyakato
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Michael Schomaker
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Tyrol, Austria
| | - Geoffrey Fatti
- Kheth'Impilo AIDS-Free Living, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Frank Tanser
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Somkhele, South Africa
| | - Jonathan Euvrard
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Khayelitsha ART Programme and Medecins Sans Frontieres, Cape Town, South Africa
| | - Nosisa Sipambo
- Harriet Shezi Children's Clinic, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Matthew P Fox
- Department of Epidemiology, Boston University School of Public Health, Boston University, Boston, Massachusetts, USA.,Health Economics & Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Andreas D Haas
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Constantin T Yiannoutsos
- Department of Biostatistics, R.M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Mary-Ann Davies
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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18
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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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19
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Incidence and predictors of loss to follow-up among human immunodeficiency virus-infected adult patients on anti-retroviral therapy at Hadiya zone public hospitals, southern Ethiopia: a retrospective cohort study. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01268-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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20
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Anukam O, Blanco N, Jumare J, Lo J, Babatunde E, Odafe S, Onotu D, Ene U, Fagbamigbe J, Carpenter D, Rivadeneira ED, Omoigberale AI, Charurat M, Swaminathan M, Stafford KA. Outcomes of HIV Positive Children and Adolescents Initiated on Antiretroviral Treatment in Nigeria (2007-2016). J Int Assoc Provid AIDS Care 2022; 21:23259582221117009. [PMID: 35929105 PMCID: PMC9358598 DOI: 10.1177/23259582221117009] [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] [Indexed: 12/04/2022] Open
Abstract
Background: This manuscript aimed to examine treatment outcomes of HIV-positive children and adolescents. Methods: We retrospectively analyzed data of a sample of patients aged 0–19 years who initiated ART (October 2007–September 2016) in participating sites in 30 states and the Federal Capital Territory in Nigeria. Results: Among 4006 patients alive at the end of the follow up period, 138 (3.4%) were LTFU. Adolescents had a significantly higher risk of being LTFU than children aged 3–5 years (HR 2.47 [95% CI 1.40-4.34]). Patients with advanced disease had a significantly higher risk of being LTFU (Stage IV HR, 3.66 [95% CI: 2.00-6.68]). On average, optimal ART refill adherence was met by 67.3% of patients. Conclusion: Our findings suggest that focusing on preventing and managing advanced disease and interventions supporting adolescents when transferring to adult care is warranted.
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Affiliation(s)
| | | | | | - Julia Lo
- 12265University of Maryland, Baltimore, MD, USA
| | | | - Solomon Odafe
- Division of Global HIV & Tuberculosis, Center for Global Health, 1242Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Dennis Onotu
- Division of Global HIV & Tuberculosis, Center for Global Health, 1242Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Uzoma Ene
- Division of Global HIV & Tuberculosis, Center for Global Health, 1242Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Johnson Fagbamigbe
- Division of Global HIV & Tuberculosis, Center for Global Health, 1242Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Deborah Carpenter
- Division of Global HIV & Tuberculosis, Center for Global Health, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emilia D Rivadeneira
- Division of Global HIV & Tuberculosis, Center for Global Health, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Austin I Omoigberale
- Paediatric Association of Nigeria, Abuja, Nigeria.,Department of Child Health, 251350University of Benin Teaching Hospital, Benin City, Nigeria
| | | | - Mahesh Swaminathan
- Division of Global HIV & Tuberculosis, Center for Global Health, 1242Centers for Disease Control and Prevention, Abuja, Nigeria
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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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Menshw T, Birhanu S, Gebremaryam T, Yismaw W, Endalamaw A. Incidence and Predictors of Loss to Follow-Up Among Children Attending ART Clinics in Northeast Ethiopia: A Retrospective Cohort Study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2021; 13:801-812. [PMID: 34408500 PMCID: PMC8364847 DOI: 10.2147/hiv.s320601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/01/2021] [Indexed: 12/27/2022]
Abstract
Background It is known that antiretroviral therapy reduces the transmission of human immunodeficiency virus and AIDS-related morbidity. The coverage of HIV drugs is increasing to control further spread of HIV and children living with HIV are the target groups in using these medications. However, loss to follow-up remains a critical challenge among these groups of the population. The aim of this study was therefore to assess the incidence and predictors of loss to follow-up among children attending antiretroviral therapy clinics. Methods A ten-year institution-based retrospective cohort study was employed among 448 children enrolled in antiretroviral therapy. Data were entered and cleaned using EpiData version 3.1 and then exported to STATA version 14 for further statistical analysis. The Kaplan–Meier survival curve was used to estimate the survival time and the Log rank test was used to compare the survival time between different categories of the explanatory variables. Multivariable Cox proportional hazards model was fitted to identify predictors of loss to follow-up and p-value < 0.05 was considered statistically significant. Results The incidence rate of loss to follow-up was 6.3 per 100 children years of observation. Being male (AHR = 2.1, CI = 1.37, 3.34), aged 1–5 years (AHR = 1.6, CI = 1.05, 2.46), poor adherence to antiretroviral therapy (AHR = 6.6; CI = 4.11, 10.66), fair adherence to antiretroviral therapy (AHR = 2.2; CI = 1.13, 4.20), regimen was not changed (AHR = 4.1; CI = 2.59, 6.45), World Health Organization stage III and IV (AHR = 2.2; CI = 1.40, 3.33) and height for age <−2 z score (AHR = 2.2; CI = 1.43, 3.44) were predictors of loss to follow-up. Conclusion Nearly seven out of 100 HIV-infected children were lost to follow-up from their link to ART clinics within a one-year follow-up. Non-modifiable demographic characteristics, clinical stage and nutritional status, and ART-related variables were associated with children’s loss to follow-up. Therefore, close monitoring of the “at risk” groups might decrease the rate of loss to follow-up. Improving adherence to antiretroviral therapy and nutritional support are also recommended.
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Affiliation(s)
- Tiruye Menshw
- Nursing Department, Mettu University, Mettu, Ethiopia
| | - Shiferaw Birhanu
- Department of Pediatrics and Child Health Nursing, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tigist Gebremaryam
- Department of Pediatrics and Child Health Nursing, Debre Markos University, Debre Markos, Ethiopia
| | - Worke Yismaw
- Nursing Department, Mettu University, Mettu, Ethiopia
| | - Aklilu Endalamaw
- Department of Pediatrics and Child Health Nursing, Bahir Dar University, Bahir Dar, Ethiopia.,Schools of Public Health, The University of Queensland, Brisbane, Australia
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Ndhlovu CE, Kouamou V, Nyamayaro P, Dougherty L, Willis N, Ojikutu BO, Makadzange AT. The transient effect of a peer support intervention to improve adherence among adolescents and young adults failing antiretroviral therapy in Harare, Zimbabwe: a randomized control trial. AIDS Res Ther 2021; 18:32. [PMID: 34134738 PMCID: PMC8207727 DOI: 10.1186/s12981-021-00356-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/08/2021] [Indexed: 12/30/2022] Open
Abstract
Background Adolescents and young adults living with HIV in sub Saharan Africa are at high risk of poor adherence to antiretroviral therapy (ART) and virologic failure (VF). Methods We conducted a randomized control trial among adolescents and young adults on ART with VF to assess the effectiveness of a community-based peer support intervention aimed at improving VF. Viral load (VL) levels were obtained at 12, 24 and 36 weeks. A subset of the participants had baseline HIV drug resistance (HIVDR) genotyped using Sanger sequencing. Results The participants’ median (interquartile range (IQR)) age was 18.1 (IQR: 15.1–20.0) years and half (50.5%, n = 107) were male. At week 24, the proportion of subjects with a detectable viremia was significantly lower in the intervention arm than in the standard of care (SOC) arm (76.0% (n = 79) vs. 89.0% (n = 96), p = 0.013). At Week 36, there remained a difference in the proportion of subjects with a detectable VL between the intervention arm (68.3%, n = 71) and SOC arm (79.6%, n = 86), which was trending towards statistical significance (p = 0.059). There was no difference in the probability of having a detectable VL over time between the intervention and SOC groups (adjusted odds ratio: 1.14, p = 0.439). Baseline HIVDR was observed in 44.0% of the participants in the intervention and 56.0% in the SOC group (p = 0.146). Conclusion A transient effect of the peer support intervention in improving VF was observed among adolescents and young people failing ART. Trial registration: This study is registered with www.clinicaltrials.gov under the reference number: NCT02833441 Supplementary Information The online version contains supplementary material available at 10.1186/s12981-021-00356-w.
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Nuwagira E, Lumori BAE, Muhindo R, Kanyesigye M, Amir A, Muyindike W, Muzoora C. Incidence and predictors of early loss to follow up among patients initiated on protease inhibitor-based second-line antiretroviral therapy in southwestern Uganda. AIDS Res Ther 2021; 18:7. [PMID: 33743748 PMCID: PMC7980600 DOI: 10.1186/s12981-021-00331-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/12/2021] [Indexed: 01/05/2023] Open
Abstract
Background Good adherence to antiretroviral therapy (ART) and retention in care are essential for the effectiveness of an HIV care program. With the current increase in numbers of people living with HIV taking second-line ART in sub-Saharan Africa, there is a need to establish their treatment outcomes and the rate of loss to follow up. In this study, we determined the incidence and predictors of loss to follow up among patients taking second-line ART at an experienced HIV treatment center in southwestern Uganda. Methods This was a retrospective review of an electronic database at Mbarara Regional Referral Hospital HIV clinic in southwestern Uganda. Second-line ART included at least two of the nucleoside reverse transcriptase inhibitors and a boosted protease inhibitor. Loss to follow-up was defined as failure to return to the health facility for care or treatment refill for 180 days or more from the previous visit. After excluding children less than 15 years, we pooled data that included socio-demographic, clinical, and laboratory data for patients who started second-line ART between 2002 and 2017. Multiple imputation was done for variables with missing data. Variables that had a p < 0.05 in unadjusted bivariate analyses were included in a multivariate binomial regression model using a stepwise backward selection procedure to describe the factors that independently predicted loss to follow-up. Results Between 2002 and 2017, 1121 patients had been initiated on second-line ART. We included data from 924 participants and of these, 518 (56.1%) were female, the mean age (SD) was 38.4 (± 10.5) years, and 433 (52.4%) had a CD4 count less than 100 cells/µl at the start of second-line ART. The incidence of loss to follow-up was 26.7 per 100 person-years. Male gender (Adjusted risk ratio (ARR) = 1.8, 95% CI 1.5–2.0) p < 0.001 and anemia ARR 1.4, 95% CI 1.1–1.6) p < 0.001 were strongly associated with loss to follow up. Conclusions There is a high incidence of loss to follow up among patients taking protease-inhibitor based second-line ART at a tertiary HIV center in southwestern Uganda. There is a need to routinely measure hemoglobin during clinic reviews, and establish mechanisms to retain males initiated on second-line ART in care. The association of anemia and loss to follow up needs to be investigated.
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Kebede HK, Mwanri L, Ward P, Gesesew HA. Predictors of lost to follow up from antiretroviral therapy among adults in sub-Saharan Africa: a systematic review and meta-analysis. Infect Dis Poverty 2021; 10:33. [PMID: 33743815 PMCID: PMC7981932 DOI: 10.1186/s40249-021-00822-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 03/08/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND It is known that 'drop out' from human immunodeficiency virus (HIV) treatment, the so called lost-to-follow-up (LTFU) occurs to persons enrolled in HIV care services. However, in sub-Saharan Africa (SSA), the risk factors for the LTFU are not well understood. METHODS We performed a systematic review and meta-analysis of risk factors for LTFU among adults living with HIV in SSA. A systematic search of literature using identified keywords and index terms was conducted across five databases: MEDLINE, PubMed, CINAHL, Scopus, and Web of Science. We included quantitative studies published in English from 2002 to 2019. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used for methodological validity assessment and data extraction. Mantel Haenszel method using Revman-5 software was used for meta-analysis. We demonstrated the meta-analytic measure of association using pooled odds ratio (OR), 95% confidence interval (CI) and heterogeneity using I2 tests. RESULTS Thirty studies met the search criteria and were included in the meta-analysis. Predictors of LTFU were: demographic factors including being: (i) a male (OR = 1.2, 95% CI 1.1-1.3, I2 = 59%), (ii) between 15 and 35 years old (OR = 1.3, 95% CI 1.1-1.3, I2 = 0%), (iii) unmarried (OR = 1.2, 95% CI 1.2-1.3, I2 = 21%), (iv) a rural dweller (OR = 2.01, 95% CI 1.5-2.7, I2 = 40%), (v) unemployed (OR = 1.2, 95% CI 1.04-1.4, I2 = 58%); (vi) diagnosed with behavioral factors including illegal drug use(OR = 13.5, 95% CI 7.2-25.5, I2 = 60%), alcohol drinking (OR = 2.9, 95% CI 1.9-4.4, I2 = 39%), and tobacco smoking (OR = 2.6, 95% CI 1.6-4.3, I2 = 74%); and clinical diagnosis of mental illness (OR = 3.4, 95% CI 2.2-5.2, I2 = 1%), bed ridden or ambulatory functional status (OR = 2.2, 95% CI 1.5-3.1, I2 = 74%), low CD4 count in the last visit (OR = 1.4, 95% CI 1.1-1.9, I2 = 75%), tuberculosis co-infection (OR = 1.2, 95% CI 1.02-1.4, I2 = 66%) and a history of opportunistic infections (OR = 2.5, 95% CI 1.7-2.8, I2 = 75%). CONCLUSIONS The current review identifies demographic, behavioral and clinical factors to be determinants of LTFU. We recommend strengthening of HIV care services in SSA targeting the aforementioned group of patients. Trial registration Protocol: the PROSPERO Registration Number is CRD42018114418.
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Affiliation(s)
- Hafte Kahsay Kebede
- Clinical Pharmacy, College of Health Sciences, Defense University, Debrezeit, Ethiopia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Paul Ward
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Hailay Abrha Gesesew
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Epidemiology Department, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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Dessu S, Mesele M, Habte A, Dawit Z. Time Until Loss to Follow-Up, Incidence, and Predictors Among Adults Taking ART at Public Hospitals in Southern Ethiopia. HIV AIDS (Auckl) 2021; 13:205-215. [PMID: 33633468 PMCID: PMC7900442 DOI: 10.2147/hiv.s296226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/29/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction According to the World Health Organization, more than seventeen million people were accessing ART in 2015 globally. Adherence to effective ART reduced the risk of transmitting the virus to uninfected persons. The government and other stakeholders’ focus was high to reduce the rate of loss to follow-up in HIV programs among patients who are already on ART follow-up, but its incidence rate increases from time to time. Methods A retrospective cohort study was conducted among the records enrolled from 1 January 2013 to 30 December 2017 at Public hospitals in Southern Ethiopia. Data were entered into Epi info V 7 and exported to STATA V 14 for analysis. The Kaplan–Meier survival curve together with a log rank test was used to estimate the survival time of the ART attending patients. Variables which had p-value <0.05 in multivariable analysis using the cox proportional hazard model were declared as statistically significant. Results The incidence rate of loss to follow-up from ART services among adults attending ART was 6.48 (95% CI:5.67,7.29) per 1000 person months. The cumulative survival probability at the end of the 10th, 20th, 40th and 60th follow-up month was 0.89 (95% CI:0.87,0.91), 0.82 (95% CI:0.79,0.85), 0.78 (95% CI:0.75,0.81) and 0.74 (95% CI:0.70,0.77), respectively. Distance >5 kilometers (AHR:3.71; 95% CI:2.32,5.95), not having registered phone number (AHR:2.52; 95% CI:1.76,3.60), not initiating Isoniazid (AHR:2.15; 95% CI:1.50,3.08), body mass index <18.50kg/m2 (AHR:1.87; 95% CI: 1.18; 2.97) and not having primary caregiver (AHR: 2.59; 95% CI: 1.84, 3.66) were statistically significant predictors of loss to follow-up. Conclusion The time until loss to follow-up was high in the first 20 months of the initiation of the ART and it declines after 20 months; longer distance between home and hospital, not having registered phone number, not initiating INH, lower body mass index and not having primary caregiver were the independent predictors of loss to follow-up from ART services.
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Affiliation(s)
- Samuel Dessu
- Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Southern Ethiopia, Ethiopia
- Correspondence: Samuel Dessu Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Southern Ethiopia, EthiopiaTel +251 910883594 Email
| | - Molalegn Mesele
- Department of Midwifery, College of Medicine and Health Sciences, Wolaita Soddo University, Wolaita, Southern Ethiopia, Ethiopia
| | - Aklilu Habte
- Department of Public Health, College of Medicine and Health Sciences, Wachamo University, Hossana, Southern Ethiopia, Ethiopia
| | - Zinabu Dawit
- Department of Nursing, Arba Minch Health Science College, Arba Minch, Southern Ethiopia, Ethiopia
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Tlhajoane M, Dzamatira F, Kadzura N, Nyamukapa C, Eaton JW, Gregson S. Incidence and predictors of attrition among patients receiving ART in eastern Zimbabwe before, and after the introduction of universal 'treat-all' policies: A competing risk analysis. PLOS GLOBAL PUBLIC HEALTH 2021; 1:e0000006. [PMID: 36962073 PMCID: PMC10021537 DOI: 10.1371/journal.pgph.0000006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/15/2021] [Indexed: 11/18/2022]
Abstract
As HIV treatment is expanded, attention is focused on minimizing attrition from care. We evaluated the impact of treat-all policies on the incidence and determinants of attrition amongst clients receiving ART in eastern Zimbabwe. Data were retrospectively collected from the medical records of adult patients (aged≥18 years) enrolled into care from July 2015 to June 2016-pre-treat-all era, and July 2016 to June 2017-treat-all era, selected from 12 purposively sampled health facilities. Attrition was defined as an absence from care >90 days following ART initiation. Survival-time methods were used to derive incidence rates (IRs), and competing risk regression used in bivariate and multivariable modelling. In total, 829 patients had newly initiated ART and were included in the analysis (pre-treat-all 30.6%; treat-all 69.4%). Incidence of attrition (per 1000 person-days) increased between the two time periods (pre-treat-all IR = 1.18 (95%CI: 0.90-1.56) versus treat-all period IR = 1.62 (95%CI: 1.37-1.91)). In crude analysis, patients at increased risk of attrition were those enrolled into care during the treat-all period, <34 years of age, WHO stage I at enrolment, and had initiated ART on the same day as HIV diagnosis. After accounting for mediating clinical characteristics, the difference in attrition between the pre-treat-all, and treat-all periods ceased to be statistically significant. In a full multivariable model, attrition was significantly higher amongst same-day ART initiates (aSHR = 1.47, 95%CI:1.05-2.06). Implementation of treat-all policies was associated with an increased incidence of ART attrition, driven largely by ART initiation on the same day as HIV diagnosis which increased significantly in the treat all period. Differentiated adherence counselling for patients at increased risk of attrition, and improved access to clinical monitoring may improve retention in care.
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Affiliation(s)
- Malebogo Tlhajoane
- Department for Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Noah Kadzura
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Constance Nyamukapa
- Department for Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Jeffrey W Eaton
- Department for Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Simon Gregson
- Department for Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
- Biomedical Research and Training Institute, Harare, Zimbabwe
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Nigussie F, Alamer A, Mengistu Z, Tachbele E. Survival and Predictors of Mortality Among Adult HIV/AIDS Patients Initiating Highly Active Antiretroviral Therapy in Debre-Berhan Referral Hospital, Amhara, Ethiopia: A Retrospective Study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2020; 12:757-768. [PMID: 33239921 PMCID: PMC7680687 DOI: 10.2147/hiv.s274747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/06/2020] [Indexed: 12/02/2022]
Abstract
Background Acquired immune deficiency syndrome is one of the most destructive epidemics the world has ever witnessed. An estimated 36.9 million people were living with HIV in 2017. HIV/AIDS is the major contributing factor for morbidity and mortality in low- and middle-income countries. Although different studies on survival and predictors of mortality among HIV/AIDS patients after initiation of antiretroviral therapy were conducted, there are inconsistencies in the findings of those studies. Furthermore, to the authors’ knowledge, there was a dearth of studies conducted in this study area. Purpose The purpose of this study was to assess the survival and predictors of mortality among adult patients starting highly active antiretroviral therapy at Debre Berhan Referral Hospital, North Showa, Amhara, Ethiopia. Patients and Methods An institution-based retrospective study was conducted among the medical records of 447 study subjects’ selected using simple random sampling from January 1t, 2013 to December 30, 2018. The data was collected using a structured data abstraction checklist and analyzed using Kaplan–Meier statistics and Cox regression models. Results Among 447 adult patients, 54 patients (12.1%) had died, giving a crude death rate of 4.18 per 100 person years (95% CI=3.20–5.45). The overall estimated survival rate after initiation of antiretroviral therapy was 81.7% (95% CI=75.36–86.54%) at 72 months of follow-up. The independent predictors of mortality were clinical stage IV (HR=15.6, 95% CI=6.609–36.948), baseline opportunistic infections (HR=1.86, 95% CI=1.048–3.330), baseline Hgb<10 mg/dL (HR=4.655, 95% CI=2.253–9.619), baseline CD4<200 cells/µL (HR=4.71, 95% CI=2.275–9.751), the presence of comorbidity (HR=2.56 95% CI=1.391–4.740), being widowed (HR=3.475, 95% CI=1.412–8.550), and bedridden functional status (HR=3.069, 95% CI=1.111–8.480). Conclusion Patients with opportunistic infections, advanced clinical stage disease, bedridden functional status, baseline Hgb<10 mg/dL, baseline CD4<200 cells/µL, and comorbidity should be given special care.
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Affiliation(s)
- Fetene Nigussie
- Department of Nursing, College of Health Science, Institute of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
| | - Abayneh Alamer
- Department of Physiotherapy, College of Health Sciences, Ayder Comprehensive Specialized Hospital, Mekelle University, Mekelle, Ethiopia
| | - Zuriyash Mengistu
- Department of Nursing, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Erdaw Tachbele
- Department of Nursing, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Matsena Zingoni Z, Chirwa T, Todd J, Musenge E. Competing risk of mortality on loss to follow-up outcome among patients with HIV on ART: a retrospective cohort study from the Zimbabwe national ART programme. BMJ Open 2020; 10:e036136. [PMID: 33028546 PMCID: PMC7539573 DOI: 10.1136/bmjopen-2019-036136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 08/24/2020] [Accepted: 09/01/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To determine the loss to follow-up (LTFU) rates at different healthcare levels after antiretroviral therapy (ART) services decentralisation among ART patients who initiated ART between 2004 and 2017 using the competing risk model in addition to the Kaplan-Meier and Cox regressions analysis. DESIGN A retrospective cohort study. SETTING The study was done in Zimbabwe using a nationwide routinely collected HIV patient-level data from various health levels of care facilities compiled through the electronic patient management system (ePMS). PARTICIPANTS We analysed 390 771 participants aged 15 years and above from 538 health facilities. OUTCOMES The primary endpoint was LTFU defined as a failure of a patient to report for drug refill for at least 90 days from last appointment date or if the patient missed the next scheduled visit date and never showed up again. Mortality was considered a secondary outcome if a patient was reported to have died. RESULTS The total exposure time contributed was 1 544 468 person-years. LTFU rate was 5.75 (95% CI 5.71 to 5.78) per 100 person-years. Adjustment for the competing event independently increased LTFU rate ratio in provincial and referral (adjusted sub-HRs (AsHR) 1.22; 95% CI 1.18 to 1.26) and district and mission (AsHR 1.47; 95% CI 1.45 to 1.50) hospitals (reference: primary healthcare); in urban sites (AsHR 1.61; 95% CI 1.59 to 1.63) (reference: rural); and among adolescence and young adults (15-24 years) group (AsHR 1.19; 95% CI 1.16 to 1.21) (reference: 35-44 years). We also detected overwhelming association between LTFU and tuberculosis-infected patients (AsHR 1.53; 95% CI 1.45 to 1.62) (reference: no tuberculosis). CONCLUSIONS We have observed considerable findings that 'leakages' (LTFU) within the ART treatment cascade persist even after the decentralisation of health services. Risk factors for LTFU reflect those found in sub-Saharan African studies. Interventions that retain patients in care by minimising any 'leakages' along the treatment cascade are essential in attaining the 90-90-90 UNAIDS fast-track targets.
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Affiliation(s)
- Zvifadzo Matsena Zingoni
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Institute of Health Research, Ministry of Health and Child Care, Harare, Zimbabwe
| | - Tobias Chirwa
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jim Todd
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Eustasius Musenge
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Birhanu MY, Leshargie CT, Alebel A, Wagnew F, Siferih M, Gebre T, Kibret GD. Incidence and predictors of loss to follow-up among HIV-positive adults in northwest Ethiopia: a retrospective cohort study. Trop Med Health 2020; 48:78. [PMID: 32943978 PMCID: PMC7488994 DOI: 10.1186/s41182-020-00266-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/26/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite the rapid expansion of antiretroviral therapy services, 'loss to follow-up' is a significant public health concern globally. Loss to follow-up of individuals from ART has a countless negative impact on the treatment outcomes. There is, however, limited information about the incidence and predictors of loss to follow-up in our study area. Thus, this study aimed to determine the incidence rate and predictors of loss to follow-up among adult HIV patients on ART. METHODS A retrospective cohort study was undertaken using 484 HIV patients between January 30, 2008, and January 26, 2018, at Debre Markos Referral Hospital. All eligible HIV patients who fulfilled the inclusion criteria were included in this study. Data were entered into Epi-data Version 4.2 and analyzed using STATATM Version 14.0 software. The Nelson-Aalen cumulative hazard estimator was used to estimate the hazard rate of loss to follow-up, and the log-rank test was used to compare the survival curve between different categorical variables. Both bivariable and multivariable Cox-proportional hazard regression models were fitted to identify predictors of LTFU. RESULTS Among a cohort of 484 HIV patients at Debre Markos Referral Hospital, 84 (17.36%) were loss their ART follow-up. The overall incidence rate of loss to follow-up was 3.7 (95% CI 3.0, 5.0) per 100 adult-years. The total LTFU free time of the participants was 2294.8 person-years. In multivariable Cox-regression analysis, WHO stage IV (AHR 2.8; 95% CI 1.2, 6.2), having no cell phone (AHR 1.9; 95% CI 1.1, 3.4), and rural residence (AHR 0.6; 95% CI 0.37, 0.99) were significant predictors of loss to follow-up. CONCLUSION The incidence of loss to ART follow-up in this study was low. Having no cell phone and WHO clinical stage IV were causative predictors, and rural residence was the only protective factor of loss to follow-up. Therefore, available intervention modalities should be strengthened to mitigate loss to follow-up by addressing the identified risk factors.
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Affiliation(s)
- Molla Yigzaw Birhanu
- Department of Public Health, College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Cheru Tesema Leshargie
- Department of Public Health, College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Animut Alebel
- Department of Public Health, College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Fasil Wagnew
- Department of Public Health, College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Melkamu Siferih
- Department of Gynecology and Obstetrics, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Tsige Gebre
- Department of Public Health, College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Getiye Dejenu Kibret
- Department of Public Health, College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
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Risk factors for loss to follow-up from antiretroviral therapy programmes in low-income and middle-income countries. AIDS 2020; 34:1261-1288. [PMID: 32287056 DOI: 10.1097/qad.0000000000002523] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Loss to follow-up (LTFU) rates from antiretroviral treatment (ART) programmes in low- and middle-income countries (LMIC) are high, leading to poor treatment outcomes and onward transmission of HIV. Knowledge of risk factors is required to address LTFU. In this systematic review, risk factors for LTFU are identified and meta-analyses performed. METHODS PubMed, Embase, Psycinfo and Cochrane were searched for studies that report on potential risk factors for LTFU in adults who initiated ART in LMICs. Meta-analysis was performed for risk factors evaluated by at least five studies. Pooled effect estimates and their 95% confidence intervals (95% CI) were calculated using random effect models with inverse variance weights. Risk of bias was assessed and sensitivity analyses performed. RESULTS Eighty studies were included describing a total of 1 605 320 patients of which 87.4% from sub-Saharan Africa. The following determinants were significantly associated with an increased risk of LTFU in meta-analysis: male sex, older age, being single, unemployment, lower educational status, advanced WHO stage, low weight, worse functional status, poor adherence, nondisclosure, not receiving cotrimoxazole prophylactic therapy when indicated, receiving care at secondary level and more recent year of initiation. No association was seen for CD4 cell count, tuberculosis at baseline, regimen, and geographical setting. CONCLUSION There are several sociodemographic, clinical, patient behaviour, treatment-related and system level risk factors for LTFU from ART programs. Knowledge of risk factors should be used to better target retention interventions and develop tools to identify high-risk patients.
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Kouamou V, Varyani B, Shamu T, Mapangisana T, Chimbetete C, Mudzviti T, Manasa J, Katzenstein D. Drug Resistance Among Adolescents and Young Adults with Virologic Failure of First-Line Antiretroviral Therapy and Response to Second-Line Treatment. AIDS Res Hum Retroviruses 2020; 36:566-573. [PMID: 32138527 DOI: 10.1089/aid.2019.0232] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Barriers to sustainable virologic suppression (VS) of HIV-infected adolescents and young adults include drug resistance mutations (DRMs) and limited treatment options, which may impact the outcome of second-line antiretroviral therapy (ART). We sequenced plasma viral RNA from 74 adolescents and young adults (16-24 years) failing first-line ART at Newlands Clinic, Zimbabwe between October 2015 and December 2016. We evaluated first-line nucleoside reverse transcriptase inhibitor (NRTI) susceptibility scores to first- and second-line regimens. Boosted protease inhibitor (bPI)-based ART was provided and viral load (VL) monitored for ≥48 weeks. Fisher's exact test was used to evaluate factors associated with VS on second-line regimens, defined as VL <1,000 copies/mL (VS1,000) or <50 copies/mL (VS50). The 74 participants on first-line ART had a median [interquartile range (IQR)] age of 18 (16-21) years and 42 (57%) were female. The mean (±standard deviation) duration on ART was 5.5 (±3.06) years and the median (IQR) log10 VL was 4.26 (3.78-4.83) copies/mL. After switching to a second-line PI regimen, 88% suppressed to <1,000 copies/mL and 76% to <50 copies/mL at ≥48 weeks. A new NRTI was associated with increased VS50 (p = .031). These 74 adolescents and young adults failing first-line ART demonstrated high levels (97%) of DRMs, despite enhanced adherence counseling. Switching to new NRTIs in second-line improved VS. With the widespread adoption of generic dolutegravir, lamivudine and tenofovir combinations in Africa, genotyping to determine NRTI susceptibility, may be warranted.
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Affiliation(s)
- Vinie Kouamou
- Department of Medicine, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Bhavini Varyani
- Department of Molecular Biology, Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Tichaona Mapangisana
- Division of Epidemiology and Biostatistics, University of Stellenbosch, Stellenbosch, South Africa
| | - Cleophas Chimbetete
- Newlands Clinic, Newlands, Harare, Zimbabwe
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Tinashe Mudzviti
- Newlands Clinic, Newlands, Harare, Zimbabwe
- School of Pharmacy, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Justen Manasa
- Department of Medical Microbiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - David Katzenstein
- Department of Molecular Biology, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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Abebe Moges N, Olubukola A, Micheal O, Berhane Y. HIV patients retention and attrition in care and their determinants in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2020; 20:439. [PMID: 32571232 PMCID: PMC7310275 DOI: 10.1186/s12879-020-05168-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/17/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND There is paucity of evidence on the magnitude of HIV patients' retention and attrition in Ethiopia. Hence, the aim of this study was to determine the pooled magnitude of HIV patient clinical retention and attrition and to identify factors associated with retention and attrition in Ethiopia. METHODS Systematic review and meta-analysis were done among studies conducted in Ethiopia using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Both published and unpublished studies conducted from January 1, 2005 to June 6th, 2019 were included. Major databases and search engines such as Google Scholar, PUBMED, African Journals Online (AJOL) and unpublished sources were searched to retrieve relevant articles. Data were assessed for quality, heterogeneity and publication bias. Analysis was conducted using STATA version 14 software. RESULT From a total of 45 studies 546,250 study participants were included in this review. The pooled magnitude of retention in care among HIV patients was 70.65% (95% CI, 68.19, 73.11). The overall magnitude of loss to follow up 15.17% (95% CI, 11.86, 18.47), transfer out 11.17% (95% CI, 7.12, 15.21) and death rate were 6.75% (95% CI, 6.22, 7.27). Major determinants of attrition were being unmarried patient (OR 1.52, 95% CI: 1.15-2.01), non-disclosed HIV status (OR 6.36, 95% CI: 3.58-11.29), poor drug adherence (OR 6.60, 95% CI: 1.41-30.97), poor functional status (OR 2.11, 95% CI: 1.33-3.34), being underweight (OR 2.21, 95% CI: 1.45-3.39) and advanced clinical stage (OR 1.85, 95% CI: 1.36-2.51). Whereas absence of opportunistic infections (OR 0.52, 95% CI: 0.30-0.9), normal hemoglobin status (OR 0.29, 95% CI: 0.20-0.42) and non-substance use (OR 95% CI: 0.41, 0.17-0.98) were facilitators of HIV patient retention in clinical care. CONCLUSION The level of retention to the care among HIV patients was low in Ethiopia. Socio-economic, clinical, nutritional and behavioral, intervention is necessary to achieve adequate patient retention in clinical care.
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Affiliation(s)
- Nurilign Abebe Moges
- Department of Public Health, College of Health Sciences, Debre Markos University, Debre Markos, Ethiopia
- Pan African University, Life and Earth Sciences Including Health and Agriculture Institute (PAULESI), University of Ibadan, Ibadan, Nigeria
| | - Adesina Olubukola
- Department of Obstetrics and Gynecology, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Okunlola Micheal
- Department of Obstetrics and Gynecology, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Yemane Berhane
- Department of Epidemiology, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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Kamacooko O, Mayanja Y, Bagiire D, Namale G, Hansen CH, Seeley J. Predictors of lost to follow-up in a "test and treat" programme among adult women with high-risk sexual behavior in Kampala, Uganda. BMC Public Health 2020; 20:353. [PMID: 32183759 PMCID: PMC7079529 DOI: 10.1186/s12889-020-8439-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/02/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Immediate uptake of antiretroviral therapy (ART) after an HIV-positive diagnosis (Test and Treat) is now being implemented in Uganda. Data are limited on lost to follow-up (LTFU) in high-risk cohorts that have initiated 'Test and Treat'. We describe LTFU in a cohort of women of high-risk sexual behaviour who initiated ART under "Test and Treat". METHODS We performed a retrospective cohort study of participant records at the Good Health for Women Project (GHWP) clinic, a clinic in Kampala for women at high-risk of HIV-infection. We included HIV positive women ≥18 years who initiated ART at GHWP between August 2014 and March 2018. We defined LTFU as not taking an ART refill for ≥3 months from the last clinic appointment among those not registered as dead or transferred to another clinic. We used the Kaplan-Meier technique to estimate time to LTFU after ART initiation. Predictors of LTFU were assessed using a multivariable Cox proportional hazards model. RESULTS The mean (±SD) age of the 293 study participants was 30.3 (± 6.5) years, with 274 (94%) reporting paid sex while 38 (13%) had never tested for HIV before enrolment into GHWP. LTFU within the first year of ART initiation was 16% and the incidence of LTFU was estimated at 12.7 per 100 person-years (95%CI 9.90-16.3). In multivariable analysis, participants who reported sex work as their main job at ART initiation (Adjusted Hazards Ratio [aHR] =1.95, 95%CI 1.10-3.45), having baseline WHO clinical stage III or IV (aHR = 2.75, 95% CI 1.30-5.79) were more likely to be LTFU. CONCLUSION LTFU in this cohort is high. Follow up strategies are required to support women on Test and Treat to remain on treatment, especially those who engage in sex work and those who initiate ART at a later stage of disease.
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Affiliation(s)
- Onesmus Kamacooko
- MRC/UVRI & LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, P. O Box 49, Entebbe, Uganda.
| | - Yunia Mayanja
- MRC/UVRI & LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, P. O Box 49, Entebbe, Uganda
| | - Daniel Bagiire
- MRC/UVRI & LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, P. O Box 49, Entebbe, Uganda
| | - Gertrude Namale
- MRC/UVRI & LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, P. O Box 49, Entebbe, Uganda
| | - Christian Holm Hansen
- MRC/UVRI & LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, P. O Box 49, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Janet Seeley
- MRC/UVRI & LSHTM Uganda Research Unit, Plot 51-59 Nakiwogo Road, P. O Box 49, Entebbe, Uganda.,London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Sifa JS, Manortey S, Talboys S, Ansa GA, Houphouet EE. Risk factors for loss to follow-up in human immunodeficiency virus care in the Greater Accra Regional Hospital in Ghana: a retrospective cohort study. Int Health 2020; 11:605-612. [PMID: 31185084 DOI: 10.1093/inthealth/ihz043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/12/2019] [Accepted: 05/09/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Loss of human immunodeficiency virus (HIV)-positive patients to follow-up increases HIV-related morbidity and mortality. This study identified the factors associated with loss to follow-up (LTFU) in an urban health facility in Ghana. METHODS A 12-y retrospective study was conducted using routinely collected data from the National Acquired Immune Deficiency Syndrome (AIDS) Control Programme (NACP) on persons living with HIV/AIDS (PLWHA) who initiated antiretroviral therapy (ART) from 2006 to 2017 at the Greater Accra Regional Hospital. Convenience sampling was used to select the study area. All gathered data were exported to Stata 14 statistical software for analysis. RESULTS A total of 4330 PLWHA initiated ART between January 2006 and December 2017. Of these, 1166 (26.9%) were lost to follow-up over the 12-y period. The factors associated with LTFU included being a Muslim (adjusted hazard ratio [aHR] 1.31 [95% confidence interval {CI} 1.05 to 1.65]), having CD4 <250 cells/ml (aHR 1.45 [95% CI 1.21 to 1.76]) and completing adherence counselling (aHR 1.58 [95% CI 1.31 to 1.92]). Having other sources of health care funding and disclosure of one's disease status were found to be protective (aHR 0.74 [95% CI 0.58 to 0.94] and 0.80 [95% CI 0.65 to 0.98], respectively). CONCLUSIONS Some of the determinants of LTFU in the hospital are comparable to those found in other parts of Africa and could be addressed using existing interventions.
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Affiliation(s)
- Jerry S Sifa
- Ensign College of Public Health, Akosombo, Ghana.,University of Ghana Health Services, Accra, Ghana
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Teshale AB, Tsegaye AT, Wolde HF. Incidence and predictors of loss to follow up among adult HIV patients on antiretroviral therapy in University of Gondar Comprehensive Specialized Hospital: A competing risk regression modeling. PLoS One 2020; 15:e0227473. [PMID: 31978137 PMCID: PMC6980595 DOI: 10.1371/journal.pone.0227473] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/19/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Loss to follow up after the initiation of antiretroviral therapy (ART) is common in Africa, particularly in Ethiopia and it is a considerable obstacle for the effectiveness of the ART program. Mortality is a competing risk of loss to follow up but it is often overlooked and there is limited evidence about the incidence and predictors of loss to follow up in the presence of competing events. OBJECTIVE To assess the Incidence and predictors of loss to follow up among adult HIV patients on ART in University of Gondar Comprehensive Specialized Hospital between January 1, 2015, and December 31, 2018. METHODS Institution based retrospective follow up study was conducted in University of Gondar Comprehensive Specialized Hospital. A Gray's test and cumulative incidence curve were used to compare the cumulative incidence function of loss to follow up. Bivariable and multivariable competing risk regression models were fitted to identify the predictors of lost to follow up and those variables with p-value <0.05 in the multivariable analysis was considered as significant predictors of lost to follow up. RESULT A total of 531 adult HIV patients on ART were included in the analysis. The incidence rate of loss to follow up in this study was 10.90 (95% CI: 8.9-13.2) per 100 person years. Being age group 15-30 years (aSHR = 2.01; 95%CI;1.11-3.63), being daily laborer(aSHR = 2.60; 95%CI;1.45-4.66), not receiving cotrimoxazole preventive therapy (aSHR = 2.66; 95%CI;1.68-4.21), not receiving isoniazid preventive therapy(aSHR = 4.57; 95% CI;1.60-13.08), ambulatory functional status (aSHR = 1.61; 95% CI; 1.02-2.51) and taking AZT-3TC-NVP medication at start of ART(aSHR = 2.01; 95% CI; 1.16-3.78) were significant predictors of lost to follow up. CONCLUSION In this study the incidence of lost to follow up was high. Young people, daily laborer, ambulatory patients and those taking AZT-3TC-NVP as well as those who did not take opportunistic prophylaxis were at higher risk of loss to follow up. Therefore, giving special attention to the high-risk groups for lost to follow up highlighted in this study could decrease the rate of LTFU.
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Affiliation(s)
- Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adino Tesfahun Tsegaye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Haileab Fekadu Wolde
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Assemie MA, Leshargie CT, Petrucka P. Outcomes and factors affecting mortality and successful tracing among patients lost to follow-up from antiretroviral therapy in Pawi Hospital, Northwest Ethiopia. Trop Med Health 2019; 47:52. [PMID: 31719791 PMCID: PMC6836319 DOI: 10.1186/s41182-019-0181-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/26/2019] [Indexed: 11/10/2022] Open
Abstract
Background Loss to follow-up (LTFU) is a major public health problem to antiretroviral therapy (ART) programs in sub-Saharan Africa. Failure to account for patients' LTFU outcomes (self-transfers and restarts) can result in inaccurate reporting of retention in care. In Ethiopia, specifically in the Benishangule Gumuz region, high LTFU reported patients, who were not assessed for their outcomes, are identified as a gap. Therefore, our objective was to determine the outcomes (alive or dead) of patients lost to follow-up (LTFU) from ART and identify factors associated with successful tracing and mortality of these patients. Results The proportion of successful tracing was 75.5% (249 of 330). Among the traced patients (n = 249), 22.9% were deceased, 47.8% were on ART, and 29.3% had discontinued treatment. However, the remaining untraceable patients were not locatable due to wrong addresses (53.1%), change of residence (29.6%), and/or lack of functional phone contact (17.3%). Some (32.9%) of the patients discontinued because of negative test results, others (21.9%) for spiritual reasons or side effects (28.8%), and the remaining (16.4%) for other reasons. Tracing using phone numbers (AOR = 2.97, 95% CI 1.57-5.59) and existing long-term follow-up period for ART (AOR = 2.13, 95% CI 1.17-3.88) were strong predictors of successful tracing while not receiving cotrimoxazole preventive therapy (CPT) (AOR = 2.59, 95% CI 1.22-5.39) is a predictor for mortality of patients post-LTFU. Conclusion ART programs need to retain current contact information of patients or guardians/friends for tracing. Having phone contact numbers and prolonged lengths of compliance with ART are predictors of successful tracing, while lack of cotrimoxazole preventive therapy is a predictor of mortality. Early tracing of beginners (newly admitted recipients) and updating their detailed information at each follow-up visit is essential.
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Affiliation(s)
- Moges Agazhe Assemie
- 1Department of Public Health, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Cheru Tesema Leshargie
- 2Department of Environmental Health, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Pammla Petrucka
- 3College of Nursing, University of Saskatchewan, Saskatoon, Canada.,4School of Life Sciences and Bioengineering, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
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Assemie MA, Alene M, Ketema DB, Mulatu S. Treatment failure and associated factors among first line patients on highly active antiretroviral therapy in Ethiopia: a systematic review and meta-analysis. Glob Health Res Policy 2019; 4:32. [PMID: 31687474 PMCID: PMC6820995 DOI: 10.1186/s41256-019-0120-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 09/09/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) restores immune function and reduces human immunodeficiency virus (HIV) related adverse outcomes. The results of previous studies in Ethiopia were replete with inconsistent findings; nonexistence of national representative figures and determinant factors are found as significant gap. The aim of this systematic review and meta-analysis was to assess the existing evidence on ART treatment failure and associated factors in Ethiopia. METHODS Relevant studies on ART treatment failure were retrieved from international databases: PubMed, Google Scholar, Scopus, and Science Direct systematically prior to March 14, 2019. All identified studies reporting the proportion of first line treatment failure among HIV patients in Ethiopia were included. Two authors independently extracted all necessary data using a standardized data extraction format. A random-effects model was used to calculate pooled estimates and associated factors in Stata/se Version-14. The Cochrane Q test statistics and I 2 tests were used to assess the heterogeneity of the studies. RESULTS From 18 articles reviewed; the pooled proportion of first line treatment failure among ART users in Ethiopia was 15.3% (95% CI: 12, 18.6) with (I 2 = 97.9%, p < 0.001). The subgroup analysis by World Health Organization (WHO) treatment failure assessment criteria were carried out, accordingly the highest prevalence (11.5%) was noted on immunological and the lowest (5.8%) was observed virological treatment failure. We had found poor adherence (OR = 8.6, 95% CI: 5.6, 13.4), not disclosed (OR = 2.1, 95% CI: 1.5, 3.0), advanced WHO clinical stage III/IV (OR = 2.4, 95% CI: 1.5, 3.8), change in regimen (OR = 2.5, 95% CI: 1.6, 3.9) and being co-infected (OR = 2.56, 95% CI: 2.2, 3.0) were statistically significant factors for treatment failure. CONCLUSION In this study, treatment failure among ART users in Ethiopia was significant. Adherence, co-infection, advanced WHO clinical stage, regimen change, and disclosure are determinant factors for treatment failure. Therefore, improve drug adherence, prevent co-infection, close follow up, and prevent HIV-drug resistance are required in future remedial efforts.
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Affiliation(s)
- Moges Agazhe Assemie
- Department of Public Health, College of Health Science Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Muluneh Alene
- Department of Public Health, College of Health Science Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Daniel Bekele Ketema
- Department of Public Health, College of Health Science Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Selishi Mulatu
- Department of Nursing, School of Health Science Bahir Dar University, Bahir Dar, Ethiopia
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Berry KM, Rodriguez CA, Berhanu RH, Ismail N, Mvusi L, Long L, Evans D. Treatment outcomes among children, adolescents, and adults on treatment for tuberculosis in two metropolitan municipalities in Gauteng Province, South Africa. BMC Public Health 2019; 19:973. [PMID: 31331311 PMCID: PMC6647101 DOI: 10.1186/s12889-019-7257-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 06/28/2019] [Indexed: 11/12/2022] Open
Abstract
Background Gauteng Province has the second lowest tuberculosis (TB) incidence rate in South Africa but the greatest proportion of TB/HIV co-infection, with 68% of TB patients estimated to have HIV. TB treatment outcomes are well documented at the national and provincial level; however, knowledge gaps remain on how outcomes differ across detailed age groups. Methods Using data from South Africa’s National Electronic TB Register (ETR), we assessed all-cause mortality and loss to follow-up (LTFU) among patients initiating treatment for TB between 01/2010 and 12/2015 in the metropolitan municipalities of Ekurhuleni Metropolitan Municipality and the City of Johannesburg in Gauteng Province. We excluded patients who were missing age, had known drug-resistance, or transferred into TB care from sites outside the two metropolitan municipalities. Among patients assigned a treatment outcome, we investigated the association between age group at treatment initiation and mortality or LTFU (treatment interruption of ≥2 months) within 10 months after treatment initiation using Cox proportional hazard models and present hazard ratios and Kaplan-Meier survival curves. Results We identified 182,890 children (<10 years), young adolescent (10–14), older adolescent (15–19), young adult (20–24), adult (25–49), and older adult (≥50) TB cases without known drug-resistance. ART coverage among HIV co-infected patients was highest for young adolescents (64.3%) and lowest for young adults (54.0%) compared to other age groups (all over 60%). Treatment success exceeded 80% in all age groups (n = 170,017). All-cause mortality increased with age. Compared to adults, young adults had an increased hazard of LTFU (20–24 vs 25–49 years; aHR 1.43 95% CI: 1.33, 1.54) while children, young adolescents, and older adults had lower hazard of LTFU. Patients with HIV on ART had a lower risk of LTFU, but greater risk of death when compared to patients without HIV. Conclusions Young adults in urban areas of Gauteng Province experience a disproportionate burden of LTFU and low coverage of ART among co-infected patients. This group should be targeted for interventions aimed at improving clinical outcomes and retention in both TB and HIV care.
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Affiliation(s)
- Kaitlyn M Berry
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Carly A Rodriguez
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Rebecca H Berhanu
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.,Health Economics and Epidemiology Research Office, Faculty of Health Sciences, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Postnet Suite 212, Private Bag X2600, Houghton, Johannesburg, 2041, South Africa
| | - Nazir Ismail
- National Institute for Communicable Diseases, Johannesburg, South Africa.,Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Faculty of Health Sciences, Department of Internal Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - Lindiwe Mvusi
- National Department of Health, Tuberculosis Cluster, Pretoria, South Africa
| | - Lawrence Long
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.,Health Economics and Epidemiology Research Office, Faculty of Health Sciences, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Postnet Suite 212, Private Bag X2600, Houghton, Johannesburg, 2041, South Africa
| | - Denise Evans
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, Department of Internal Medicine, School of Clinical Medicine, University of the Witwatersrand, Postnet Suite 212, Private Bag X2600, Houghton, Johannesburg, 2041, South Africa.
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Mekonnen N, Abdulkadir M, Shumetie E, Baraki AG, Yenit MK. Incidence and predictors of loss to follow-up among HIV infected adults after initiation of first line anti-retroviral therapy at University of Gondar comprehensive specialized Hospital Northwest Ethiopia, 2018: retrospective follow up study. BMC Res Notes 2019; 12:111. [PMID: 30819236 PMCID: PMC6396485 DOI: 10.1186/s13104-019-4154-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/22/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The aim of this study was to estimate the incidence of lost to follow up from anti-retroviral therapy (ART) care and identify the associated factors among human immunodeficiency virus (HIV) infected patients after first-line ART initiation at University of Gondar comprehensive specialized hospital, Northwest Ethiopia between January 2012 and January 2018. RESULTS The overall incidence rate of lost to follow up was 12.26 per 100 person years (95% CI (10.61-14.18)). Being underweight (< 18.5 kg/m2) (AHR, 1.52, 95% CI 1.01-2.28), jobless (AHR, 2.22, 95% CI 1.2-4.11), substance abuser (AHR, 1.84 95% CI 1.19-2.86), having sub-optimal adherence (fair/poor) (AHR 6.33, 95% CI (3.90-10.26)), not receiving isoniazid prophylaxis (AHR 2.47, 95% CI (1.36-4.48)), ambulatory functional status (AHR 1.94, 95% CI (1.23-3.06)), having opportunistic infections (AHR, 1.74 95% CI 1.11-2.72), having CD4 count 201-349 cells/µL (AHR 0.58, 95% CI (0.38-0.88)) were found to be significant predictors of lost to follow up from ART service.
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Affiliation(s)
- Nebiyu Mekonnen
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohamed Abdulkadir
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eleyias Shumetie
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adhanom Gebreegziabher Baraki
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melaku Kindie Yenit
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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