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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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Gagliardini R, Giacomelli A, Bozzi G, D'Arminio Monforte A, Tavelli A, Mazzotta V, Bruzzesi E, Cervo A, Saracino A, Mussini C, Girardi E, Cozzi-Lepri A, Antinori A. Impact of COVID-19 pandemic on retention in care of native and migrant people with HIV in the ICONA cohort. Travel Med Infect Dis 2024; 58:102691. [PMID: 38336335 DOI: 10.1016/j.tmaid.2024.102691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/19/2023] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND COVID-19 pandemic challenged the UNAIDS 90-90-90 targets. How the COVID-19 pandemic affected HIV retention in care and whether it has disproportionally affected migrant people with HIV (PWH) remained to be investigated. METHODS PWH in ICONA Cohort in follow-up in each of the study periods were included: 01/09/2019-29/02/2020 (pandemic period) and 01/03/2018-31/08/2018 (historical period, as a control). Risk of temporary loss to follow-up (LTFU, defined as no data recorded for a person for one year) was analyzed by logistic regression, with migrant status as the main exposure variable. Difference in difference (DID) analysis was applied to evaluate the effect of COVID-19 pandemic in the different risk of LTFU between natives and migrants. RESULTS 8864 (17.1% migrants) and 8071 (16.8% migrants) PWH constituted the pandemic and the historical period population, respectively. Proportion of PWH defined as LTFU in the pandemic period was 10.5% in native and 19.6% in migrant PWH. After controlling for age, sex and geographical location of enrolling site, risk of temporary LTFU was higher for migrants than native PWH [adjusted odds ratio 1.85 (95%CI 1.54-2.22)] in pandemic period. In PWH contributing to both periods, LTFU was 9.0% (95% CI 8.3-9.8) in natives vs 17.0% (95% CI 14.7-19.4) in migrants during the pandemic. Instead, LTFU was 1.2% (95%CI 0.9, 1.5) in natives vs 2.2% (95% CI 1.3-3.1) in migrants during the historical period, with a resulting DID of 7.0% (95% CI 4.4-9.6). CONCLUSIONS A greater proportion of LTFU in migrant PWH was observed in both periods, which remained unaltered over time. Interventions to reduce LTFU of migrants are necessary.
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Affiliation(s)
- Roberta Gagliardini
- Clinical and Research Infectious Diseases Department, National Institute of Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Giacomelli
- III Infectious Disease Unit, ASST-Fatebenefratelli Sacco, Milan, Italy
| | - Giorgio Bozzi
- Infectious Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | | | | | - Valentina Mazzotta
- Clinical and Research Infectious Diseases Department, National Institute of Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Elena Bruzzesi
- UO Malattie Infettive, IRCCS Ospedale San Raffaele, Italy
| | - Adriana Cervo
- Division of Infectious Diseases, University of Modena, Modena, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, University Hospital, University of Bari, Bari, Italy
| | - Cristina Mussini
- Division of Infectious Diseases, University of Modena, Modena, Italy
| | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London, UK
| | - Andrea Antinori
- Clinical and Research Infectious Diseases Department, National Institute of Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
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Benti Biratu S, Addis Gesese A. Determinants of Loss to Follow Up Among Adult People Living with HIV Enrolled in Antiretroviral Therapy in West Wollega Public Hospitals, Oromia, Ethiopia. HIV AIDS (Auckl) 2024; 16:59-71. [PMID: 38435497 PMCID: PMC10906723 DOI: 10.2147/hiv.s426196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 02/01/2024] [Indexed: 03/05/2024] Open
Abstract
Background Antiretroviral Treatment (ART) reduces morbidity and mortality in patients with human immunodeficiency virus (HIV). However, clients loss to follow-up (LTFU) from the treatment poses a paramount problem to the public, healthcare, and patient outcome. Thus, this study identified determinants of loss to follow-up to ART among adult clients in West Wollega hospitals, Oromia, Ethiopia, in 2021. Methods An unmatched case-control study was conducted and a systematic random sampling technique was used. Data were collected from patient charts by three BSC nurses and three card reporters using a structured checklist. Then, it was entered into Epi-data version 3.1 and analyzed using SPSS version 21. Descriptive statistics (frequency and percentage) were used to present the results. Bivariate and multivariable logistic regression analyses were performed using the backward stepwise method. Adjusted odds ratio (AOR) and p-values <0.05 were used to declare significant association with loss to follow-up. Model fitness was checked using Hosmer-Lemeshow goodness-of-fit. Results A total of 399 (133 patients and 266 controls) participated in this study. Rural residents (AOR:3.46, 95% CI:1.65, 7.25), male patient (AOR: 2.65 95% CI 1.54,4.55), lack of formal education (AOR: 4.35, 95% CI 1.53, 12.41), base line CD4 ≤350 (AOR: 5.25, 95% CI 1.93,14.24), poor functional status (AOR: 4.298, 95% CI 5.33,34.62) and WHO stages III & IV (AOR: 2.65, 95% CI 1.68,4.19), and tuberculosis co-infection (AOR: 2.82, 95% CI 1.11,7.45) were determinant factors of loss to follow up. Conclusion Rural residence, male sex, daily laborer, no formal education, baseline CD4 count <350 cells/mm3, baseline advanced WHO clinical stage, and TB co-infection were determinants of LTFU. Therefore, emphasis should be given to the identified factors along with awareness creation and health education sessions. Regular TB screening, optimal adherence regardless of their stay on ART, and follow-up study are recommended.
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Affiliation(s)
- Siraj Benti Biratu
- Department of Public Health, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Abreha Addis Gesese
- Department of Clinical Nursing, Gambella Teachers Education and Health Science College, Gambella, Ethiopia
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Ichite A, Jean-Gilles M, Rosenberg R, Abbamonte J, Dévieux JG. Assessing the Preliminary Efficacy of a Nonrandomized, Clinic-Based HIV Risk Reduction Pilot Intervention for PrEP-Initiated, Alcohol- and Other Drug-Using Women of Color in Miami, FL. J Racial Ethn Health Disparities 2023; 10:3077-3094. [PMID: 36648620 PMCID: PMC10645637 DOI: 10.1007/s40615-022-01482-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 01/18/2023]
Abstract
In this paper, we assessed the preliminary efficacy and acceptability of a quasi-experimental, clinic-based sexual risk reduction pilot intervention for pre-exposure prophylaxis (PrEP)-initiated, alcohol- and other drug-using women of color and explored their self-reported barriers to, and facilitators of, PrEP use. Using a mixed methods design, analyses incorporated pre- and post-intervention study assessment data from 38 women and semi-structured process evaluations using a subsample of 25. The intervention administered over an 8-week period consisted of 4 one-on-one in person educational sessions, a process evaluation, and study assessments conducted at baseline and 3 and 6 months. Post intervention, statistically significant changes in sexual risk scores were not observed; however, we found significant decreases in alcohol use (Z = - 3.02, p = .003, η2 = .41). Process evaluation data revealed interpersonal relationships as a key motivator for PrEP initiation as well as a prominent barrier to PrEP use; these relationships rarely facilitated adherence. Overall, women found the intervention to be acceptable and reported a wide range of benefits of participation-most notably its therapeutic benefits. Findings from this study provide preliminary evidence of the potential for the Talking PrEP with Women of Color intervention to improve risky behaviors, knowledge, and attitudes related to sexual risk taking. Furthermore, findings suggest that interventions to increase PrEP uptake and adherence in at-risk women may benefit from supporting them in accurately estimating their risk for HIV and increasing their sense of social support.
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Affiliation(s)
- Amanda Ichite
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public, Health and Social Work, Florida International University, Miami, FL, 33199, USA.
| | - Michèle Jean-Gilles
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public, Health and Social Work, Florida International University, Miami, FL, 33199, USA
| | - Rhonda Rosenberg
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public, Health and Social Work, Florida International University, Miami, FL, 33199, USA
| | - John Abbamonte
- Department of Educational and Psychological Studies, Counseling Psychology Area, University of Miami, Coral Gables, FL, 33146, USA
| | - Jessy G Dévieux
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public, Health and Social Work, Florida International University, Miami, FL, 33199, USA
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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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Tugume L, Semitala FC, Owachi D, Kagimu E, Kamya MR, Meya DB. Clinical characteristics and morbidity among hospitalized adults with advanced HIV disease in Uganda during 'test and treat' era. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002457. [PMID: 37851597 PMCID: PMC10584089 DOI: 10.1371/journal.pgph.0002457] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/13/2023] [Indexed: 10/20/2023]
Abstract
Nearly four decades after the first case of AIDS was described, the global number of AIDS-related deaths has steadily declined but falls short of the elimination targets, especially in sub-Saharan Africa. Despite interventions to promote early HIV diagnosis and treatment, hospitalization and mortality related to advanced HIV disease (AHD) remains a significant public health problem in Uganda. We assessed the HIV treatment history and causes of hospitalization among in-patients with AHD at a tertiary hospital in Uganda. In this cross-sectional study, pre-hospitalization HIV treatment history and clinical characteristics of HIV-positive in-patients with CD4<200 cells/μL or WHO stage 3 or 4 clinical events were assessed. Descriptive data were summarized using percentages and medians. Among hospitalized adults with AHD from November 2021 to June 2022, 74% (260/353) knew their HIV status prior to hospitalization and 62% (219/353) were ART experienced at presentation. The median time since ART initiation was 28 months (IQR; 2-97). Overall, 73% (258/353) had at least two etiological diagnoses and the majority (non-mutually exclusive) were diagnosed with tuberculosis (61.2%), cryptococcal meningitis (20.7%), mucosal candidiasis (16.1%) and bacterial infections (15%). In conclusion, nearly two-thirds of in-patients with advanced HIV disease were ART experienced prior to hospitalization and tuberculosis was the most common cause of hospitalization. Innovative strategies to strengthen HIV diagnosis, linkage, and retention in HIV care and to increase coverage of TB preventive therapy are urgently needed.
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Affiliation(s)
- Lillian Tugume
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fred C. Semitala
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Kiruddu National Referral Hospital, Kampala, Uganda
- Makerere University Joint AIDS Program, Kampala, Uganda
| | | | - Enock Kagimu
- Department of Research, Infectious Diseases Institute Makerere University, Kampala, Uganda
| | - Moses R. Kamya
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - David B. Meya
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Research, Infectious Diseases Institute Makerere University, Kampala, Uganda
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Makurumidze R, Decroo T, Jacobs BKM, Rusakaniko S, Van Damme W, Lynen L, Gils T. Attrition one year after starting antiretroviral therapy before and after the programmatic implementation of HIV "Treat All" in Sub-Saharan Africa: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:558. [PMID: 37641003 PMCID: PMC10463759 DOI: 10.1186/s12879-023-08551-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Evidence on the real-world effects of "Treat All" on attrition has not been systematically reviewed. We aimed to review existing literature to compare attrition 12 months after antiretroviral therapy (ART) initiation, before and after "Treat All" was implemented in Sub-Saharan Africa and describe predictors of attrition. METHODS We searched Embase, Google Scholar, PubMed, and Web of Science in July 2020 and created alerts up to the end of June 2023. We also searched for preprints and conference abstracts. Two co-authors screened and selected the articles. Risk of bias was assessed using the modified Newcastle-Ottawa Scale. We extracted and tabulated data on study characteristics, attrition 12 months after ART initiation, and predictors of attrition. We calculated a pooled risk ratio for attrition using random-effects meta-analysis. RESULTS Eight articles and one conference abstract (nine studies) out of 8179 screened records were included in the meta-analysis. The random-effects adjusted pooled risk ratio (RR) comparing attrition before and after "Treat All" 12 months after ART initiation was not significant [RR = 1.07 (95% Confidence interval (CI): 0.91-1.24)], with 92% heterogeneity (I2). Being a pregnant or breastfeeding woman, starting ART with advanced HIV, and starting ART within the same week were reported as risk factors for attrition both before and after "Treat All". CONCLUSIONS We found no significant difference in attrition before and after "Treat All" one year after ART initiation. While "Treat All" is being implemented widely, differentiated approaches to enhance retention should be prioritised for those subgroups at risk of attrition. PROSPERO NUMBER CRD42020191582 .
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Affiliation(s)
- Richard Makurumidze
- Institute of Tropical Medicine, Clinical Sciences Department, Antwerp, Belgium.
- Faculty of Medicine and Health Sciences, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe.
- Faculty of Medicine & Pharmacy, Gerontology, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
| | - Tom Decroo
- Institute of Tropical Medicine, Clinical Sciences Department, Antwerp, Belgium
- Research Foundation of Flanders, Brussels, Belgium
| | - Bart K M Jacobs
- Institute of Tropical Medicine, Clinical Sciences Department, Antwerp, Belgium
| | - Simbarashe Rusakaniko
- Faculty of Medicine and Health Sciences, Department of Primary Health Care Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Wim Van Damme
- Institute of Tropical Medicine, Clinical Sciences Department, Antwerp, Belgium
- Faculty of Medicine & Pharmacy, Gerontology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lutgarde Lynen
- Institute of Tropical Medicine, Clinical Sciences Department, Antwerp, Belgium
| | - Tinne Gils
- Institute of Tropical Medicine, Clinical Sciences Department, Antwerp, Belgium
- Global Health Institute, University of Antwerp, Antwerp, Belgium
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Mburu C, Njuguna I, Neary J, Mugo C, Moraa H, Beima-Sofie K, Onyango A, Oyiengo L, Richardson BA, John-Stewart G, Wamalwa D. Mortality and Loss to Follow-Up Among Adolescents and Young Adults Attending HIV Care Programs in Kenya. AIDS Patient Care STDS 2023; 37:323-331. [PMID: 37432311 PMCID: PMC10354300 DOI: 10.1089/apc.2023.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
Mortality and loss to follow-up (LTFU) among adolescents and youth living with HIV (AYLHIV) remain high. We evaluated mortality and LTFU during the test and treat era. We abstracted medical records of AYLHIV for 10-24 years between January 2016 and December 2017 in 87 HIV clinics in Kenya. Using competing risk survival analysis, we compared incidence rates and determined correlates of mortality and LTFU among newly enrolled [<2 years since antiretroviral therapy (ART) initiation] and AYLHIV on ART for ≥2 years. Among 4201 AYLHIV, 1452 (35%) and 2749 (65%) were new enrollments and on ART for ≥2 years, respectively. AYLHIV on antiretroviral therapy (ART) for ≥2 years were younger and more likely to have perinatally acquired HIV (p < 0.001). Incidence of mortality and LTFU per 100 person-years were 2.32 [95% confidence interval (CI): 1.64-3.28] and 37.8 (95% CI: 34.7-41.3), respectively, among new enrollments and 1.22 (95% CI: 0.94-1.59) and 10.2 (95% CI: 9.3-11.1), respectively, among those on ART for ≥2 years. New enrollments had almost twice higher risk of mortality [subdistribution hazard ratio (sHR) 1.92 (1.30, 2.84), p = 0.001] and sevenfold higher risk of LTFU [sHR 7.71 (6.76, 8.79), p < 0.001] than those on ART for ≥2 years. Among new enrollments, mortality was higher in males and those with World Health Organization (WHO) stage III/IV disease at enrollment, and LTFU was associated with pregnancy, older age, and nonperinatal acquisition. Female sex and WHO stage (I/II) were associated with LTFU among those on ART for ≥2 years. During the study period from January 1, 2016, to December 31, 2017, the mortality incidence observed did not demonstrate improvement from earlier studies despite universal test and treat and better ART regimens. This trial was registered with ClinicalTrials.gov, NCT03574129.
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Affiliation(s)
- Caren Mburu
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Irene Njuguna
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Jillian Neary
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Cyrus Mugo
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Hellen Moraa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Alvin Onyango
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Laura Oyiengo
- United Nations International Emergency Children's Fund, Department of Maternal and Newborn Health
| | - Barbra A. Richardson
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
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Mushy SE, Mtisi E, Mboggo E, Mkawe S, Yahya-Malima KI, Ndega J, Ngalesoni F, Muya A. Predictors of the observed high prevalence of loss to follow-up in ART-experienced adult PLHIV: a retrospective longitudinal cohort study in the Tanga Region, Tanzania. BMC Infect Dis 2023; 23:92. [PMID: 36788523 PMCID: PMC9926646 DOI: 10.1186/s12879-023-08063-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) programs have expanded rapidly, and they are now accessible free of charge, yet "loss to follow-up, LTFU" is still a national public health issue. LTFU may result in treatment failure, hospitalization, increased risk of opportunistic infections and drug-resistant strains, and shortening the quality of life. This study described the rates and predictors of LTFU among adults living with human immunodeficiency virus (PLHIV) on ART in the Tanga region, Tanzania. METHODS A retrospective longitudinal cohort study was conducted between October 2018 and December 2020 in Tanga's care and treatment health services facilities. The participants were HIV adult PLHIV aged 15 years and above on ART and attended the clinic at least once after ART initiation. LTFU was defined as not taking ART refills for 3 months or beyond from the last attendance of a refill and not yet classified as dead or transferred out. Cox proportional hazard regression models were employed to identify risk factors for LTFU. P values were two-sided, and we considered a p < 0.05 statistically significant. RESULTS 57,173 adult PLHIV were on ART of them, 15,111 (26.43%) were LTFU, of whom 10,394 (68.78%) were females, and 4717 (31.22%) were males. Factors independently associated with LTFU involved age between 15 and 19 years (HR: 1.85, 95% CI 1.66-2.07), male sex (HR: 2.00 95% CI 1.51-2.62), divorce (HR: 1.35, 95% CI 1.24-1.48), second-line drug type (HR: 1.13, 95% CI 1.09-1.18), poor drug adherence (HR: 1.50, 95% CI 1.23-1.75), unsuppressed viral load (HR: 2.15, 95% CI 2.02-2.29), not on DTG-related drug (HR: 7.51, 95% CI 5.88-10.79), advanced HIV disease WHO stage III and IV (HR: 2.51, 95% CI 2.32-2.72). In contrast to cohabiting, ART duration < 1 year, and being pregnant showed a reduced likelihood of LTFU. CONCLUSION A high prevalence of LTFU was observed in this study. Young age, not using DTG-based regimen, WHO clinical stage IV, poor drug adherence, male sex, unsuppressed viral load, divorcee, and second-line regime were independently associated with LTFU. To reduce LTFU, evidence-based interventions targeting the identified risk factors should be employed.
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Affiliation(s)
- Stella E. Mushy
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Amref Health Africa, Ali Hassan Mwinyi Road, Dar es Salaam, Tanzania
| | - Expeditho Mtisi
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of General Studies, Dar Es Salaam Institute of Technology, Dar es Salaam, Tanzania
| | - Eric Mboggo
- Amref Health Africa, Ali Hassan Mwinyi Road, Dar es Salaam, Tanzania
| | - Simon Mkawe
- Amref Health Africa, Ali Hassan Mwinyi Road, Dar es Salaam, Tanzania
| | - Khadija I. Yahya-Malima
- Department of Nursing Management, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - John Ndega
- Amref Health Africa, Ali Hassan Mwinyi Road, Dar es Salaam, Tanzania
| | - Frida Ngalesoni
- Amref Health Africa, Ali Hassan Mwinyi Road, Dar es Salaam, Tanzania
| | - Aisa Muya
- Amref Health Africa, Ali Hassan Mwinyi Road, Dar es Salaam, Tanzania
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Alebel A, Sibbritt D, Petrucka P, Demant D. Undernutrition increased the risk of loss to follow-up among adults living with HIV on ART in Northwest Ethiopia: a retrospective cohort study. Sci Rep 2022; 12:22556. [PMID: 36581708 PMCID: PMC9800382 DOI: 10.1038/s41598-022-27077-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022] Open
Abstract
This study aims to examine the effect of undernutrition on loss to follow-up (LTFU) in adults living with human immunodeficiency virus (HIV) receiving antiretroviral therapy (ART) in Ethiopia. We conducted an institution-based retrospective cohort study using medical records of 844 adults living with HIV receiving ART between June 2014 and June 2020 at Debre Markos Comprehensive Specialized Hospital (Northwest Ethiopia). The effect of undernutrition on LTFU was examined using a proportional hazards regression model after adjusting potential confounders. The significance level was set at p < 0.05. At the end of the study period, 109 (12.9%) participants were considered LTFU, with an overall LTFU incidence of 5.3 per 100 person-years (95% CI 4.4, 6.4). The incidence of LTFU was higher in undernourished participants (8.2 per 100 person-years) compared to well-nourished participants (4.3 per 100 person-years). After adjusting for potential confounders, the adjusted risk of LTFU among undernourished participants was two times higher than in their well-nourished counterparts (AHR [adjusted hazard ratio]: 2.1, 95% CI 1.4, 3.2). This study found that undernutrition significantly increased the risk of LTFU among adults living with HIV on ART.
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Affiliation(s)
- Animut Alebel
- grid.449044.90000 0004 0480 6730College of Health Science, Debre Markos University, Debre Markos, Ethiopia ,grid.117476.20000 0004 1936 7611School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW Australia
| | - David Sibbritt
- grid.117476.20000 0004 1936 7611School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW Australia
| | - Pammla Petrucka
- grid.25152.310000 0001 2154 235XCollege of Nursing, University of Saskatchewan, Saskatoon, Canada ,grid.451346.10000 0004 0468 1595School of Life Sciences and Bioengineering, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
| | - Daniel Demant
- grid.117476.20000 0004 1936 7611School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW Australia ,grid.1024.70000000089150953School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD Australia
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Mandawa MB, Mahiti GR. Factors Contributing to Loss to Follow-Up from HIV Care Among Men Living with HIV/AIDS in Kibaha District, Tanzania. HIV/AIDS - RESEARCH AND PALLIATIVE CARE 2022; 14:503-516. [PMID: 36389001 PMCID: PMC9656329 DOI: 10.2147/hiv.s381204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022]
Abstract
Purpose Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) remains a global public health challenge and epidemic disease in sub-Saharan African (SSA) countries. Retention in HIV care should be emphasized to reach”, 95-95-95” the Joint United Nations Program on HIV/AIDS (UNAIDS) target by 2030. In Tanzania, in spite of existing strategies to ensure retention, loss to follow-up (LTFU) among HIV-infected men is still a common challenge. With limited studies focusing on men’s population, little is known on their perspectives on factors contributing to LTFU. This study aimed to explore factors contributing to LTFU among men living with HIV/AIDS in the Kibaha district and to try to formulate strategies that work for men. Methods The qualitative study using a phenomenological approach was conducted among 16 men with experience in LTFU from three HIV care and treatment clinics located in the Kibaha district. Purposive sampling was used to select informants for semi-structured in-depth interviews from August to December, 2021. The collected data was analyzed thematically. Results The findings were grouped into three themes which highlightedthe contribution of individual factors, socio-economic factors and health system factors. These factors include anticipated HIV-related stigma, lack of disclosure of their HIV status to their partners, poor knowledge on HIV care, unbearable antiretroviral (ART) medication side effects, sharing of ART medications with their partners, perceived good health status, financial difficulties, work-related travels, demanding employment schedules, spiritual belief in faith healing, poor conduct among healthcare workers and loss of Care and Treatment Clinic (CTC) cards hindered their use of ART services at clinics. Conclusion The findings from this study revealed linked multi-level factors that influence LTFU from HIV care among HIV-infected men. In order to retain men in HIV care, tailored intervention approaches should be formulated.
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Affiliation(s)
- Mathew Bernard Mandawa
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
- Correspondence: Mathew Bernard Mandawa, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Da-es-Salaam, Tanzania, Tel +255 654 452 445, Email
| | - Gladys Reuben Mahiti
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
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Bantie B, Abate MW, Nigat AB, Birlie TA, Dires T, Minuye T, Kerebeh G, Tiruneh CM, Moges N, Chanie ES, Feleke DG, Mulu AT, Demssie B, Fentie TA, Abate MD, Abate M, Ali AS, Dessie G. Attrition rate and its predictors among adults receiving anti-retroviral therapy following the implementation of the "Universal Test and Treat strategy" at public health institutions in Northern Ethiopia. A retrospective follow-up study. Heliyon 2022; 8:e11527. [PMID: 36411907 PMCID: PMC9674913 DOI: 10.1016/j.heliyon.2022.e11527] [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: 03/19/2022] [Revised: 05/10/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Since 2016, the Ethiopian Federal Ministry of Health has adopted a "Universal Test and Treat" strategy to treat human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). In this test and treat era, access to anti-retroviral therapy (ART) has been rapidly expanded. On the other hand, poor retention of patients on ART remains a serious concern for reaching ART program goals. Thus, this study is targeted at investigating the attrition rate and its predictors among HIV-positive adults following the implementation of the "test and treat" strategy in Ethiopia. Methods An institution-based retrospective follow-up study was conducted among 1048 HIV-positive adults receiving ART at public health institutions in Bahir Dar city, Northern Ethiopia. Data were extracted from randomly selected patient charts, entered into Epidata 4.6 and exported to Stata 14.2 for analysis. Kaplan-Meier curve was used to estimate individuals' attrition-free probability at each specific point in time. Both bivariable and multivariable cox regression models were fitted, and variables with a P-value of <0.05 in the multivariable model were considered as significant predictors of attrition. Results A total of 1020 (97.3%) study participants were included in the final analysis. The attrition rate of individuals was 15 per 100 person-years of observation (95% CI: 13.5-16.9 per 100 PYO). World Health organization (WHO) stage III/IV clinical diseases (Adjusted hazard ratio/AHR/1.75 (95% CI:1.24-2.48)), Not disclosing HIV-status (AHR 1.6 (95% CI: 1.24-2.05)), rapid initiation of ART (AHR 2.05 (95%CI:1.56-7.69)), No history of ART regime change (AHR2.03 (95% CI: 1.49-2.76)), "1J (TDF_3TC-DTG)" ART regimen (AHR 0.46 (95%CI: 2.18-3.65)), and Poor ART adherence (AHR2.82 (95%CI: 2.18-3.65)) were identified as significant predictors of attrition rate of HIV positive adults. Conclusion Following the implementation of the universal test and treat area, the attrition rate of adults living with (HIV) found to be high. Due attention shall be provided to those individuals who didn't disclose their status, were initiated into ART within seven days, had WHO stage III/IV clinical disease, had poor adherence history, had no regimen change, and are not on 1J (TDF_3TC-DTG) ART regimen type.
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Affiliation(s)
- Berihun Bantie
- Department of Comprehensive Nursing, College of Health Science, Debre Tabor University, Ethiopia
| | - Moges Wubneh Abate
- Department of Comprehensive Nursing, College of Health Science, Debre Tabor University, Ethiopia
| | - Adane Birhanu Nigat
- Department of Comprehensive Nursing, College of Health Science, Debre Tabor University, Ethiopia
| | - Tekalign Amera Birlie
- Department of Comprehensive Nursing, College of Health Science, Debre Tabor University, Ethiopia
| | - Tadila Dires
- Department of Comprehensive Nursing, College of Health Science, Debre Tabor University, Ethiopia
| | - Tigabu Minuye
- Department of Comprehensive Nursing, College of Health Science, Debre Tabor University, Ethiopia
| | - Gashaw Kerebeh
- Department of Pediatrics and Child Health, College of Health Science, Debre Tabor University, Ethiopia
| | - Chalie Marew Tiruneh
- Department of Pediatrics and Child Health, College of Health Science, Debre Tabor University, Ethiopia
| | - Natnael Moges
- Department of Pediatrics and Child Health, College of Health Science, Debre Tabor University, Ethiopia
| | - Ermias Sisay Chanie
- Department of Pediatrics and Child Health, College of Health Science, Debre Tabor University, Ethiopia
| | - Dejen Getaneh Feleke
- Department of Pediatrics and Child Health, College of Health Science, Debre Tabor University, Ethiopia
| | - Animut Tilahun Mulu
- Department of Biomedical Science, College of Health Science, Debre Tabor University, Ethiopia
| | - Biruk Demssie
- Department of Social and Public Health, College of Health Science, Debre Tabor University, Ethiopia
| | - Tigabinesh Assfaw Fentie
- Department of Social and Public Health, College of Health Science, Debre Tabor University, Ethiopia
| | - Melsew Dagne Abate
- Department of Nursing, College of Health Science, Woldia University, Ethiopia
| | - Makda Abate
- Department of Nursing, College of Medicine and Health Science, Debre Birhan University, Ethiopia
| | - Awoel Seid Ali
- Department of Adult Health Nursing, School of Health Science, College of Medicine and Health Science, Bahir dar University, Ethiopia
| | - Getenet Dessie
- Department of Nursing, College of Medicine and Health Science, Debre Birhan University, Ethiopia
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Ntabanganyimana D, Rugema L, Omolo J, Nsekuye O, Malamba SS. Incidence and factors associated with being lost to follow-up among people living with HIV and receiving antiretroviral therapy in Nyarugenge the central business district of Kigali city, Rwanda. PLoS One 2022; 17:e0275954. [PMID: 36228004 PMCID: PMC9562217 DOI: 10.1371/journal.pone.0275954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/26/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Lost to follow-up (LTFUP) continues to threaten the sustainability of antiretroviral therapy (ART) benefits and success of ART programs. We determined the incidence and predictors of LTFUP among people living with HIV (PLHIV) on ART in Nyarugenge the Central Business District of Kigali city. METHODS A cohort of PLHIV who initiated ART in 2018 was retrospectively studied for 24 months. Using health facility records, a person who had no record of contact with the health facility for at least three consecutive months was considered LTFUP. LTFUP incidence rates were computed, and the Fine-Gray's competing risk regression models were used to determine factors associated with time to first LTFUP. Generalized estimating equations (GEEs) were used to analyze repeated measurement outcomes of LTFUP and predictors of LTFUP. RESULTS Of 950 participants, 581 (61.2%) were females and 866 (91.2%) were 15 to 49 years old. From 1,586.1 person years of observation (pyo), 148 participants got LTFUP for 451 times. The incidence rate to first event was 9.4 per 100 pyo (95%CI:7.9-10.9) and 31.8 per 100 pyo (95%CI:29.0-34.4) to multiple events. WHO stage, marital status, employment status and person to contact when PLHIV is not reachable were associated with time to first LTFUP event. However, an average participant with a contact person who was not a Community Health Worker (CHW) or a peer educator had higher incidence of LTUP (aIRR = 2.69, 95%CI: 1.43-5.06), an average single patients had higher incidence of LTFUP (aIRR = 1.74, 95%CI: 1.28-2.34) compared to married/co-habiting, and an average self-employed had higher incidence of LTFUP (aIRR = 1.51, 95%CI: 1.14-2.01) compared to participants employed by others. Furthermore, an average PLHIV living out-of-the health facility catchment area had higher incidence of LTFUP (aIRR = 1.55, 95%CI: 1.19-2.01) compared to an average PLHIV living in the health facility catchment area whereas, an average children initiated on first line had lower incidence of LTUP (aIRR = 0.43, 95%CI: 0.21-0.86) compared to adults. CONCLUSION Using CHW and peer educators as contact persons can help to reduce LTFUP while, targeted sensitization and service delivery are needed for single, self-employed and, patients living out of the health facility catchment area.
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Affiliation(s)
- Daniel Ntabanganyimana
- Rwanda Field Epidemiology and Laboratory Training Program, Department of Epidemiology and Biostatistics, University of Rwanda, Kigali, Rwanda
- Ministry of Health, Kigali, Rwanda
- * E-mail:
| | - Lawrence Rugema
- University of Rwanda/School of Public Health, Kigali, Rwanda
| | - Jared Omolo
- CGH DGHT, Centers for Disease Control and Prevention, Kigali, Rwanda
| | - Olivier Nsekuye
- Rwanda Field Epidemiology and Laboratory Training Program, Department of Epidemiology and Biostatistics, University of Rwanda, Kigali, Rwanda
- Rwanda Biomedical Centre, Public Health Surveillance & Emergency Preparedness and Response, Kigali, Rwanda
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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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Mwamuye IC, Karanja S, Msanzu JB, Adem A, Kerich M, Ngari M. Factors associated with poor outcomes among people living with HIV started on anti-retroviral therapy before and after implementation of "test and treat" program in Coastal Kenya. PLoS One 2022; 17:e0270653. [PMID: 36129876 PMCID: PMC9491584 DOI: 10.1371/journal.pone.0270653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 06/14/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To determine the factors associated with poor outcomes among people living with HIV (PLHIV) started on anti- retroviral therapy before and after implementation of "Test and treat" program in 18 facilities in Coastal Kenya. METHODS A retrospective cohort study design was used to study PLHIV aged > 15 years and started on ART in the periods of April to August 2016, and April to August 2017, then followed up for 24 months. Primary outcome was retention defined as being alive and on ARVs after 24 months. Death and loss to follow-up were considered as poor outcomes. Kaplan-Meier survival methods were used to describe time to primary outcome. Cox proportional regression analysis was used to determine factors associated with poor outcomes. RESULTS 86 patients (470 before test and treat, and 316 after test and treat cohorts) were enrolled. Overall, the median [IQR] age was 39.3 [32.5-47.5] years and 539 (69%) were female. After 24 months, retention rates for the before (68%) and after (64%) test and start groups were similar (absolute difference: -4.0%, 95%CI: -11-3.1, P = 0.27). There were 240(31%, 95%CI 27 to 34%) PLHIV with poor outcomes, 102 (32%) and 138 (29%) occurred among the test and treat group, and delayed treatment patients respectively. In multivariable regression model, test and treat had no significant effect on risk of poor outcomes (aHR = 1.17, 95%CI 0.89-1.54). Increasing age (aHR = 0.98, 95%CI 0.97-0.99), formal employment (aHR = 0.42, 95%CI 0.23-0.76) and not being employed (aHR = 0.53, 95%CI 0.34-0.81) were negatively associated with poor outcomes. The risk of poor outcomes was higher among males compared to female patients (aHR = 1.37, 95%CI 1.03-1.82) and among divorced/separated patients compared to the married (aHR = 1.44, 95%CI 1.04-1.99). CONCLUSION Retention patterns for the "test and treat" cohort were comparable to those who started ART before "test and treat". Patients who are males, young, divorced/separated, with poor socio-economic status had higher risks for poor clinical outcomes. Interventions targeting PLHIV who are young, male and economically disadvantaged provide an opportunity to improve the long-term outcomes.
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Affiliation(s)
| | - Simon Karanja
- Jomo Kenyatta University of Agriculture and Technology, Mombasa, Kenya
| | | | - Aggrey Adem
- Technical University of Mombasa, Mombasa, Kenya
| | - Mary Kerich
- Jomo Kenyatta University of Agriculture and Technology, Mombasa, Kenya
| | - Moses Ngari
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
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Ssemwogerere A, Kamya JK, Nuwasasira L, Ahura C, Isooba DI, Wakida EK, Obua C, Migisha R. Self-transfers and factors associated with successful tracing among persons lost to follow-up from HIV care, Sheema District, Southwestern Uganda: retrospective medical records review, 2017-2021. AIDS Res Ther 2022; 19:44. [PMID: 36127692 PMCID: PMC9487036 DOI: 10.1186/s12981-022-00471-2] [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: 05/25/2022] [Accepted: 09/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to improved coverage and scale-up of antiretroviral therapy (ART), patients are increasingly transferring between ART-providing sites. Self-transfers may constitute a high proportion of patients considered lost to follow-up (LTFU), and if overlooked when reporting patients who have dropped out of HIV care, may result in an incorrect estimation of retention. We determined the prevalence of self-transfers, and successful tracing, and identified associated factors among people living with HIV (PLHIV) LTFU from care at public health facilities in Sheema District, Southwestern Uganda. METHODS We conducted a cross-sectional retrospective medical records review during February and March 2022. We included records of all PLHIV who were LTFU from 2017 to 2021, and who were registered at government-owned ART clinics in Sheema District. LTFU was considered for those who were not taking ART refills for a period of ≥ 3 months. We abstracted demographic and clinical data from medical records at the selected clinics. Participants were traced via phone calls or in-person to ascertain the outcomes of LTFU. We performed multivariate modified Poisson regression to identify factors associated with self-transfer, and successful tracing. RESULTS Overall, 740 patients were identified as LTFU from three ART-providing clinics; of these, 560 (76%) were self-transfers. The mean age was 30 (SD ± 10) years, and most (69%, n = 514) were female; the majority (87%, 641/740) were successfully traced. Age (adjusted prevalence ratio [aPR] = 1.13, 95% CI 1.01-1.25, P = 0.026 for those aged 18-30 years compared to > 30 years), female sex (aPR = 1.18, 95% CI 1.11-1.25, P < 0.001), and having WHO clinical stage 1-2 (aPR = 2.34, 95% CI 1.89-3.91, P < 0.001) were significantly associated with self-transfer. Presence of a phone contact in the patient's file (aPR = 1.10, 95% CI 1.01-1.90, P = 0.026) was associated with successful tracing of the patients considered LTFU. CONCLUSION Self-transfers accounted for the majority of patients recorded as LTFU, highlighting the need to account for self-transfers among patients considered LTFU, to accurately estimate retention in care. ART-providing facilities should regularly update contact information for PLHIV to enable successful tracing, in the event that the patients are LTFU. This calls for a health-tracking system that easily identifies self-transfers across ART-providing clinics using unique patient identifiers.
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Affiliation(s)
- Arnold Ssemwogerere
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Javilla Kakooza Kamya
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Lillian Nuwasasira
- Department of Pharmaceutical Sciences, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Claire Ahura
- Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Derrick Isaac Isooba
- Department of Medical Laboratory Sciences, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edith K Wakida
- Department of Medical Education, California University of Science and Medicine, San Bernardino, USA.,Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Celestino Obua
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda.,Office of the Vice Chancellor, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Richard Migisha
- Department of Physiology, Mbarara University of Science and Technology, P.O BOX 1410, Mbarara, Uganda.
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Atuhaire L, Shumba CS, Mapahla L, Nyasulu PS. A retrospective cross sectional study assessing factors associated with retention and non-viral suppression among HIV positive FSWs receiving antiretroviral therapy from primary health care facilities in Kampala, Uganda. BMC Infect Dis 2022; 22:642. [PMID: 35883042 PMCID: PMC9315841 DOI: 10.1186/s12879-022-07614-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient retention in care and sustained viral load suppression are a cornerstone to improved health and quality of life, among people living with HIV. However, challenges of retention on ART remain among female sex workers (FSWs). We report lost to follow up (LTFU), viral load suppression, and the associated factors among FSWs that access HIV treatment at primary health care facilities in Kampala. METHODS We retrospectively abstracted and analysed patient management data of HIV positive FSWs who enrolled in care between January 2018 to December 2020. LTFU was defined as failure of a FSW to return for treatment at least 90 days from the date of their last clinic appointment. We defined viral suppression as having a last viral load of ≤ 1000 copies/ml preceding data abstraction. Data were analysed using Stata 15.1 software. RESULTS A total of 275 FSWs were included in our study sample. We found low retention of 85.1% (n = 234) at six months, corresponding to LTFU of 14.9 (n = 41) within the same period. Retention decreased with duration of being in care up to 73.5% (n = 202) at 24 months, and this translates to LTFU of 26.5% (n = 73). Viral load testing coverage was 62% (n = 132) and of these, 90.9% (n = 120) were virally suppressed. Factors associated with LTFU in univariable logistic regression; and viral load suppression in multivariable logistic regression models were; having a telephone contact (OR: 0.3, 95% CI: 0.1-0.9 p = 0.031), having enrolled in HIV care aged ≥ 35 years (OR: 0.5, 95% CI: 0.2-1.0 p = 0.048), (OR:0.03, 95%CI: 0.00-0.5, p = 0.016); and having good ART adherence (OR: 0.2, 95% CI: 0.1-0.5 p = 0.001), (OR:24.0, 95% CI: 3.7-153.4 p = 0.001) respectively. Having good ART adherence remained statistically significant (OR: 0.2, 95% CI: 0.08-0.53 p = 0.001) in multivariable logistic regression for LTFU. CONCLUSION This study found low retention among HIV diagnosed FSWs in care. Viral load suppression was acceptable and comparable to that of the general population, however viral load coverage was low. Strategies that increase retention in care and access to viral load testing such as individual client centred care models are vital to improve retention and viral load coverage among FSWs.
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Affiliation(s)
- Lydia Atuhaire
- Division of Epidemiology & Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. .,Makerere University/UVRI Infection and Immunity Research Training Programme, Entebbe, Uganda.
| | - Constance S Shumba
- School of Nursing and Midwifery, Aga Khan University, Nairobi, Kenya.,Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - Lovemore Mapahla
- Division of Epidemiology & Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Peter S Nyasulu
- Division of Epidemiology & Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,School of Public Health, Faculty of Medicine and Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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18
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Tesha ED, Kishimba R, Njau P, Revocutus B, Mmbaga E. Predictors of loss to follow up from antiretroviral therapy among adolescents with HIV/AIDS in Tanzania. PLoS One 2022; 17:e0268825. [PMID: 35857796 PMCID: PMC9299289 DOI: 10.1371/journal.pone.0268825] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 05/09/2022] [Indexed: 11/30/2022] Open
Abstract
Access to Antiretroviral Therapy (ART) is threatened by the increased rate of loss to follow-up (LTFU) among adolescents on ART care. We investigated the rate of LTFU from HIV care and associated predictors among adolescents living with HIV/AIDS in Tanzania. A retrospective cohort analysis of adolescents on ART from January 2014 to December 2016 was performed. Kaplan-Meier method was used to determine failure probabilities and the Cox proportion hazard regression model was used to determine predictors of loss to follow up. A total of 25,484 adolescents were on ART between 2014 and 2016, of whom 78.4% were female and 42% of adolescents were lost to follow-up. Predictors associated with LTFU included; adolescents aged 15–19 years (adjusted hazard ratio (aHR): 1.57; 95% Confidence Interval (CI); 1.47–1.69), having HIV/TB co-infection (aHR: 1.58; 95% CI, 1.32–1.89), attending care at dispensaries (aHR: 1.12; 95% CI, 1.07–1.18) or health center (aHR: 1.10; 95% CI, 1.04–1.15), and being malnourished (aHR: 2.27; 95% CI,1.56–3.23). Moreover, residing in the Lake Zone and having advanced HIV disease were associated with LTFU. These findings highlight the high rate of LTFU and the need for intervention targeting older adolescents with advanced diseases and strengthening primary public facilities to achieve the 2030 goal of ending HIV as a public health threat.
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Affiliation(s)
- Esther-Dorice Tesha
- Department of Epidemiology and Biostatistics at Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Tanzania Field of Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania
- * E-mail:
| | - Rogath Kishimba
- Tanzania Field of Epidemiology and Laboratory Training Program, Dar es Salaam, Tanzania
| | - Prosper Njau
- National AIDS Control Program, Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Baraka Revocutus
- National AIDS Control Program, Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Elia Mmbaga
- Department of Epidemiology and Biostatistics at Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
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19
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Garcia-Rosales K, Sosa Barbaran K, Rios J, Pinto-Santini D, Del Rosario Leon M, Gallardo-Cartagena JA, MacRae J, Leon M, Valencia-Huamaní J, Montalban E, Gonzales P, Duerr A, Lama JR, Bender Ignacio R. An Ethical Imperative to Ensure Uninterrupted HIV Care Following Therapeutic Trials: One Experience in Peru. AIDS Patient Care STDS 2022; 36:205-207. [PMID: 35687815 DOI: 10.1089/apc.2022.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Katherine Garcia-Rosales
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | | | - Jessica Rios
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | - Delia Pinto-Santini
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | | | - Jorge A Gallardo-Cartagena
- Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Lima, Peru.,Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - John MacRae
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | - Mey Leon
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru
| | | | | | | | - Ann Duerr
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA.,Department of Medicine (RBI), Global Health (AD, JRL), and Epidemiology (RBI and AD), University of Washington, Seattle, Washington, USA
| | - Javier R Lama
- Asociacion Civil Impacta Salud y Educacion, Lima, Peru.,Department of Medicine (RBI), Global Health (AD, JRL), and Epidemiology (RBI and AD), University of Washington, Seattle, Washington, USA
| | - Rachel Bender Ignacio
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA.,Department of Medicine (RBI), Global Health (AD, JRL), and Epidemiology (RBI and AD), University of Washington, Seattle, Washington, USA
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20
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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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21
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Mayasi N, Situakibanza H, Mbula M, Longokolo M, Maes N, Bepouka B, Ossam JO, Moutschen M, Darcis G. Retention in care and predictors of attrition among HIV-infected patients who started antiretroviral therapy in Kinshasa, DRC, before and after the implementation of the 'treat-all' strategy. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000259. [PMID: 36962315 PMCID: PMC10022330 DOI: 10.1371/journal.pgph.0000259] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 02/13/2022] [Indexed: 11/18/2022]
Abstract
The retention of patients in care is a key pillar of the continuum of HIV care. It has been suggested that the implementation of a "treat-all" strategy may favor attrition (death or lost to follow-up, as opposed to retention), specifically in the subgroup of asymptomatic people living with HIV (PLWH) with high CD4 counts. Attrition in HIV care could mitigate the success of universal antiretroviral therapy (ART) in resource-limited settings. We performed a retrospective study of PLWH at least 15 years old initiating ART in 85 HIV care centers in Kinshasa, Democratic Republic of Congo (DRC), between 2010 and 2019, with the objective of measuring attrition and to define factors associated with it. Sociodemographic and clinical characteristics recorded at ART initiation included sex, age, weight, height, WHO HIV stage, pregnancy, baseline CD4 cell count, start date of ART, and baseline and last ART regimen. Attrition was defined as death or loss to follow-up (LTFU). LTFU was defined as "not presenting to an HIV care center for at least 180 days after the date of a last missed visit, without a notification of death or transfer". Kaplan-Meier curves were used to present attrition data, and mixed effects Cox regression models determined factors associated with attrition. The results compared were before and after the implementation of the "treat-all" strategy. A total of 15,762 PLWH were included in the study. Overall, retention in HIV care was 83% at twelve months and 77% after two years of follow-up. The risk of attrition increased with advanced HIV disease and the size of the HIV care center. Time to ART initiation greater than seven days after diagnosis and Cotrimoxazole prophylaxis was associated with a reduced risk of attrition. The implementation of the "treat-all" strategy modified the clinical characteristics of PLWH toward higher CD4 cell counts and a greater proportion of patients at WHO stages I and II at treatment initiation. Initiation of ART after the implementation of the 'treat all" strategy was associated with higher attrition (p<0.0001) and higher LTFU (p<0.0001). Attrition has remained high in recent years. The implementation of the "treat-all" strategy was associated with higher attrition and LTFU in our study. Interventions to improve early and ongoing commitment to care are needed, with specific attention to high-risk groups to improve ART coverage and limit HIV transmission.
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Affiliation(s)
- Nadine Mayasi
- Department of Internal Medicine, Infectious and Tropical Diseases, University Clinics of Kinshasa, Kinshasa, Democratic Republic of the Congo [DRC]
| | - Hippolyte Situakibanza
- Department of Internal Medicine, Infectious and Tropical Diseases, University Clinics of Kinshasa, Kinshasa, Democratic Republic of the Congo [DRC]
| | - Marcel Mbula
- Department of Internal Medicine, Infectious and Tropical Diseases, University Clinics of Kinshasa, Kinshasa, Democratic Republic of the Congo [DRC]
| | - Murielle Longokolo
- Department of Internal Medicine, Infectious and Tropical Diseases, University Clinics of Kinshasa, Kinshasa, Democratic Republic of the Congo [DRC]
| | - Nathalie Maes
- Biostatistics and Medico-Economic Information Department, University Hospital of Liège, Liège, Belgium
| | - Ben Bepouka
- Department of Internal Medicine, Infectious and Tropical Diseases, University Clinics of Kinshasa, Kinshasa, Democratic Republic of the Congo [DRC]
| | - Jérôme Odio Ossam
- Department of Internal Medicine, Infectious and Tropical Diseases, University Clinics of Kinshasa, Kinshasa, Democratic Republic of the Congo [DRC]
| | - Michel Moutschen
- Department of Internal Medicine and Infectious Diseases, Liège University Hospital, Liège, Belgium
- AIDS Reference Laboratory, University of Liège, Liège, Belgium
| | - Gilles Darcis
- Department of Internal Medicine and Infectious Diseases, Liège University Hospital, Liège, Belgium
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22
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Taghavi K, Mandiriri A, Shamu T, Rohner E, Bütikofer L, Asangbeh S, Magure T, Chimbetete C, Egger M, Pascoe M, Bohlius J. Cervical Cancer Screening Cascade for women living with HIV: a cohort study from Zimbabwe. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000156. [PMID: 36860760 PMCID: PMC9974171 DOI: 10.1371/journal.pgph.0000156] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Countries with high HIV prevalence, predominantly in sub-Sahahran Africa, have the highest cervical cancer rates globally. HIV care cascades successfully facilitated the scale-up of antiretroviral therapy. A cascade approach could similarly succeed to scale-up cervical cancer screening, supporting WHO's goal to eliminate cervical cancer. We defined a Cervical Cancer Screening Cascade for women living with HIV (WLHIV), evaluating the continuum of cervical cancer screening integrated into an HIV clinic in Zimbabwe. We included WLHIV aged ≥18 years enrolled at Newlands Clinic in Harare from June 2012-2017 and followed them until June 2018. We used a cascade approach to evaluate the full continuum of secondary prevention from screening to treatment of pre-cancer and follow-up. We report percentages, median time to reach cascade stages, and cumulative incidence at two years with 95% confidence intervals (CI). We used univariable Cox proportional hazard regressions to calculate cause-specific hazard ratios with 95% CIs for factors associated with completing the cascade stages. We included 1624 WLHIV in the study. The cumulative incidence of cervical screening was 85.4% (95% CI 83.5-87.1) at two years. Among the 396 WLHIV who received screen-positive tests in the study, the cumulative incidence of treatment after a positive screening test was 79.5% (95% CI 75.1-83.2) at two years. The cumulative incidence of testing negative at re-screening after treatment was 36.1% (95% CI 31.2-40.7) at two years. Using a cascade approach to evaluate the full continuum of cervical cancer screening, we found less-than 80% of WLHIV received treatment after screen-positive tests and less-than 40% were screen-negative at follow-up. Interventions to improve linkage to treatment for screen-positive WLHIV and studies to understand the clinical significance of screen-positive tests at follow-up among WLHIV are needed. These gaps in the continuum of care must be addressed in order to prevent cervical cancer.
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Affiliation(s)
- Katayoun Taghavi
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- The Graduate School for Cellular and Biomedical Sciences of the University of Bern, Bern, Switzerland
- * E-mail:
| | | | - Tinei Shamu
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Newlands Clinic, Harare, Zimbabwe
- The Graduate School for Health Sciences of the University of Bern, Bern, Switzerland
| | - Eliane Rohner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | | | - Serra Asangbeh
- The Graduate School for Cellular and Biomedical Sciences of the University of Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | | | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research, School of Public Health, University of Cape Town, Cape Town, South Africa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | | | - Julia Bohlius
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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23
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Alebel A, Demant D, Petrucka P, Sibbritt D. Does undernutrition increase the risk of lost to follow-up in adults living with HIV in sub-Saharan Africa? Protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e048022. [PMID: 34907042 PMCID: PMC8671928 DOI: 10.1136/bmjopen-2020-048022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Undernutrition is considered a marker for poor prognosis among people living with HIV (PLHIV), particularly in sub-Saharan Africa (SSA), where undernutrition and HIV are both highly prevalent. Evidence suggests that undernutrition (body mass index <18.5 kg/m2) is one of the main factors that significantly increases the risk of lost to follow-up (LTFU) in PLHIV. However, primary studies in SSA have reported inconsistent findings on the relationship between undernutrition and LTFU among adults living with HIV. To the best of our knowledge, no systematic review which aimed to summarise the available evidence. Hence, this review aims to determine the pooled effect of undernutrition on LTFU among adults living with HIV in SSA. METHODS AND ANALYSIS PubMed, EMBASE, Web of Science, Scopus, and, for grey literature, Google Scholar will be systematically searched to include relevant articles published since 2005. Studies reporting the effect of undernutrition on LTFU in adults living with HIV in SSA will be included. The Newcastle-Ottawa Scale will be used for quality assessment. Data from eligible studies will be extracted using a standardised data extraction tool. Heterogeneity between included studies will be assessed using Cochrane Q-test and I2 statistics. The Egger's and Begg's tests at a 5% significance level will be used to evaluate publication bias. As heterogeneity is anticipated, the pooled effect size will be estimated using a random-effects model. The final effect size will be reported using the adjusted HR with a 95% CI. ETHICS AND DISSEMINATION Ethical approval is not required for a protocol for a systematic review. The results of this systematic review will be published in a peer-reviewed journal and will be publicly available. PROSPERO REGISTRATION NUMBER CRD42021277741.
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Affiliation(s)
- Animut Alebel
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia
- School of Public Helath, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Daniel Demant
- School of Public Helath, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Pammla Petrucka
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
| | - David Sibbritt
- School of Public Helath, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
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Tomescu S, Crompton T, Adebayo J, Kinge CW, Akpan F, Rennick M, Chasela C, Ondura E, Dauda DS, Pisa PT. Factors associated with an interruption in treatment of people living with HIV in USAID-supported states in Nigeria: a retrospective study from 2000-2020. BMC Public Health 2021; 21:2194. [PMID: 34847909 PMCID: PMC8638522 DOI: 10.1186/s12889-021-12264-9] [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: 05/11/2021] [Accepted: 11/16/2021] [Indexed: 12/04/2022] Open
Abstract
Background Patient interruption of antiretroviral therapy (ART) continues to limit HIV programs’ progress toward epidemic control. Multiple factors have been associated with client interruption in treatment (IIT)— including age, gender, CD4 count, and education level. In this paper, we explore the factors associated with IIT in people living with HIV (PLHIV) in United States Agency for International Development (USAID)-supported facilities under the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program in Nigeria. Methods We conducted cross-sectional analyses on data obtained from Nigeria’s National Data Repository (NDR), representing a summarized record of 573 630 ART clients that received care at 484 PEPFAR/USAID-supported facilities in 16 states from 2000–2020. IIT was defined as no clinical contact for 28 days or more after the last expected clinical contact. Univariate and multivariate logistic regression models were computed to explore the factors associated with IIT. The variables included in the analysis were sex, age group, zone, facility level, regimen line, multi-month dispensing (MMD), and viral load category. Results Of the 573 630 clients analysed in this study, 32% have been recorded as having interrupted treatment. Of the clients investigated, 66% were female (32% had interrupted treatment), 39% were aged 25–34 at their last ART pick-up date (with 32% of them interrupted treatment), 59% received care at secondary level facilities (37% interrupted treatment) and 38% were last receiving between three- to five-month MMD (with 10% of these interrupted treatment). Those less likely to interrupt ART were males (aOR = 0.91), clients on six-month MMD (aOR = 0.01), adults on 2nd line regimen (aOR = 0.09), and paediatrics on salvage regimen (aOR = 0.02). Clients most likely to interrupt ART were located in the South West Zone (aOR = 1.99), received treatment at a tertiary level (aOR = 12.34) or secondary level facilities (aOR = 4.01), and had no viral load (VL) on record (aOR =10.02). Age group was not significantly associated with IIT. Conclusions Sex, zone, facility level, regimen line, MMD, and VL were significantly associated with IIT. MMD of three months and longer (especially six months) had better retention on ART than those on shorter MMD. Not having a VL on record was associated with a considerable risk of IIT.
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Affiliation(s)
| | | | | | | | | | | | - Charles Chasela
- Right to Care, Centurion, South Africa.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Pedro T Pisa
- Right to Care, Centurion, South Africa.,Department of Human Nutrition and Dietetics, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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25
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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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26
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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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Moges NA, Adesina OA, Okunlola MA, Berhane Y. Same-day antiretroviral treatment (ART) initiation and associated factors among HIV positive people in Northwest Ethiopia: baseline characteristics of prospective cohort. Arch Public Health 2020; 78:87. [PMID: 32983450 PMCID: PMC7510057 DOI: 10.1186/s13690-020-00473-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 09/15/2020] [Indexed: 11/30/2022] Open
Abstract
Background Despite a well-established fact that same-day or rapid ART initiation after a positive HIV test result is vital for faster viral suppression and for prevention of further sexual transmissions of HIV, there is a paucity of evidence on the uptake of same-day ART initiation among newly HIV diagnosed people in Northwest, Ethiopia. Methods A cross-sectional study was conducted between December 1st, 2018 and July 30, 2019. About 759 newly HIV diagnosed adults were recruited from 24 health facilities. Data were collected using interviewer-administered questionnaire. Data were entered using EPI-Data and exported to SPSS and STATA software for further analysis. Bivariate logistic regression was used to select candidate variables at p-value less than 0.25 for multivariate logistic regression. Then adjusted odds ratio with 95% Confidence Interval (CI) at p-value of less than 0.05 was used to declare the statistical associations between the dependent and independent variables. Result Magnitude of same-day ART initiation was 318 (41.90%) [(95% CI, 38.2–45.20%)]. Factors associated with same-day ART initiation were: Patients resided in West Gojjam Zone were 2.04 times more likely to initiate same-day ART compared to those in Bahir Dar city administration [AOR = 2.04 (1.04–3.97)], patients in the health centers were 3.06 times more likely to initiate same-day ART initiation compared to those in the hospitals [AOR = 3.06 (1.90–4.92)] and Patients who were diagnosed their HIV status at the same health facility where they linked for ART were 2.16 times more likely to initiate ART at the same-day of diagnosis [AOR = 2.16 (91.24–3.74)]. Moreover, patients with no opportunistic infection [AOR = 2.08 (1.04–4.19)] and pregnant women [AOR = 3.97 (1.78–8.87)] were more likely to initiate ART same-day of diagnosis. Conclusions Same-day ART initiation was low among HIV patients in Ethiopia. Patients attending their treatment at hospitals and those from big city (Bahir Dar) were less likely to initiate same-day ART. Clinical factors such as having opportunistic infections and non-pregnancy status affected the immediate initiation of treatment. HIV positive people who seek care in hospitals and those tested HIV positive from another health facilities in which they did not intend to continue their ART follow-up care need special attention.
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Chauke P, Huma M, Madiba S. Lost to follow up rate in the first year of ART in adults initiated in a universal test and treat programme: a retrospective cohort study in Ekurhuleni District, South Africa. Pan Afr Med J 2020; 37:198. [PMID: 33505567 PMCID: PMC7813655 DOI: 10.11604/pamj.2020.37.198.25294] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/26/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction South Africa adopted and implemented the Universal Test and Treat (UTT) strategy for HIV since 2016. However, the care outcomes for patients initiated antiretroviral therapy (ART) through the UTT strategy have not been established. We determined the rate of lost to follow up (LTFU) and associated factors in patients who were initiated on ART through the UTT and the pre-ART strategy at 12 months post ART initiation. Methods this retrospective study analyzed the records of a cohort of patients at 12 months post the initiation of ART. We extracted data from the TIER.Net electronic database of selected facilities in a sub-district in Gauteng Province, South Africa. Factors associated with LFTU at 12 months of ART were assessed and logistic regression performed to identify predictors of LFTU. Results records of 367 patients were evaluated, and 54% were initiated ART through the UTT strategy. The mean age was 36.3 years, mean CD4 cell count at ART initiation was 341 cells/mm3, and 25% were initiated at CD4 cell count above 500 cells/mm3. LTFU at 12 months was 28%, 50% were LFTU within six months, and 28% within three months of ART. LFTU in the UTT cohort was higher than in the pre-ART cohort, patients initiated through UTT were twice more likely to be LTFU (AOR = 1.84, CI: 1.13-3.00) than pre-ART patients. Conclusion the rate of LTFU at 12 months of ART was 28%, which indicate that the retention in care rate (60%) falls far short of the triple 90 targets required for viral suppression.
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Affiliation(s)
- Patricia Chauke
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Mmampedi Huma
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Sphiwe Madiba
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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