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Poor follow-up rates at a self-pay northern Indian tertiary AIDS clinic.

Maru DS, Khakha DC, Tahir M, Basu S, Sharma SK - Int J Equity Health (2007)

Bottom Line: In this small cohort of AIDS patients attending a self-pay antiretroviral clinic at a large tertiary care center in Delhi, India, follow-up rates were quite poor.These findings indicate that greater strides must be taken to improve the recruitment and retention of poor patients.The expansion of free antiretrovirals is one step among many necessary to achieve this objective.

View Article: PubMed Central - HTML - PubMed

Affiliation: AIDS Program, Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, 11029, India. sksharma@aiims.ac.in.

ABSTRACT

Background: In many developing countries, out-of-pocket payment remains a primary mechanism by which patients infected with HIV access treatment. In India, this has been changing as the National AIDS Control Organization (NACO) has been rolling out free antiretroviral therapy throughout the country since 2004. The vast majority of patients, however, remain without access to free medicines.

Methods: A retrospective chart review was performed on data obtained from a registry of ninety-three (93) patients attending a self-pay clinic at the All India Institute of Medical Sciences in Delhi, India. Multivariable Cox proportional hazard and logistic regression models were explored to assess the relationship between lost-to-follow-up status and the predictor variables: age, sex, household income, baseline CD4 count, and distance from clinic.

Results: Lost-to-follow-up rates were very high; 68% (63/93) were lost-to-follow-up till the time of chart review, including 59% (55/93) who were lost within one year. In both regression models, younger age, low baseline CD4 counts, and low income level were significantly associated with increased risk of lost-to-follow-up. Additionally, there was a significant interaction between income and CD4 counts. The patients with both low CD4 counts and low income level were more likely to be lost-to-follow-up than would be predicted by each covariable alone.

Conclusion: In this small cohort of AIDS patients attending a self-pay antiretroviral clinic at a large tertiary care center in Delhi, India, follow-up rates were quite poor. Poorer patients tended to present to clinic with more depressed CD4 counts and were less likely to be retained in care. These findings indicate that greater strides must be taken to improve the recruitment and retention of poor patients. The expansion of free antiretrovirals is one step among many necessary to achieve this objective.

No MeSH data available.


Related in: MedlinePlus

Survival function time-to-LTFU.
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Figure 1: Survival function time-to-LTFU.

Mentions: Basic demographic characteristics are shown in table 1. For those patients for whom counts were available at 6 months follow-up (n = 25), the median CD4 increase was 159 cells/microliter (Interquartile Range 34 to 254). Owing to the small number of patients with follow-up laboratory data, no further analyses were undertaken on follow-up CD4 counts. Following ARV initiation, 63 of 93 (68%) missed at least two appointments and never returned. A total of 55 patients were lost within 12 months or less, including 11 patients who did not return after their first post-ARV-initiation visit. Patients came not only from Delhi (n = 31) but also from several neighboring states, most prominently Utter Pradesh (n = 21), Haryana (n = 16), Bihar (n = 15), states with varying levels of low health infrastructure. Women tended to live closer to the clinic than men, though not significantly so (4.32 versus 7.16 hours, p-value = 0.11). Age, income, distance from clinic, and CD4 count were all significantly associated with lost-to-follow-up in preliminary bivariable analyses (table 2). The survival curve for the whole sample, assessing time to lost-to-follow-up (LTFU), shows a rapid decline within the first year following ARV initiation (Figure 1). Income, distance from clinic, and CD4 count at baseline were highly correlated; in multivariable analyses, we thus corrected for this by centering these variable around the mean.


Poor follow-up rates at a self-pay northern Indian tertiary AIDS clinic.

Maru DS, Khakha DC, Tahir M, Basu S, Sharma SK - Int J Equity Health (2007)

Survival function time-to-LTFU.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2200646&req=5

Figure 1: Survival function time-to-LTFU.
Mentions: Basic demographic characteristics are shown in table 1. For those patients for whom counts were available at 6 months follow-up (n = 25), the median CD4 increase was 159 cells/microliter (Interquartile Range 34 to 254). Owing to the small number of patients with follow-up laboratory data, no further analyses were undertaken on follow-up CD4 counts. Following ARV initiation, 63 of 93 (68%) missed at least two appointments and never returned. A total of 55 patients were lost within 12 months or less, including 11 patients who did not return after their first post-ARV-initiation visit. Patients came not only from Delhi (n = 31) but also from several neighboring states, most prominently Utter Pradesh (n = 21), Haryana (n = 16), Bihar (n = 15), states with varying levels of low health infrastructure. Women tended to live closer to the clinic than men, though not significantly so (4.32 versus 7.16 hours, p-value = 0.11). Age, income, distance from clinic, and CD4 count were all significantly associated with lost-to-follow-up in preliminary bivariable analyses (table 2). The survival curve for the whole sample, assessing time to lost-to-follow-up (LTFU), shows a rapid decline within the first year following ARV initiation (Figure 1). Income, distance from clinic, and CD4 count at baseline were highly correlated; in multivariable analyses, we thus corrected for this by centering these variable around the mean.

Bottom Line: In this small cohort of AIDS patients attending a self-pay antiretroviral clinic at a large tertiary care center in Delhi, India, follow-up rates were quite poor.These findings indicate that greater strides must be taken to improve the recruitment and retention of poor patients.The expansion of free antiretrovirals is one step among many necessary to achieve this objective.

View Article: PubMed Central - HTML - PubMed

Affiliation: AIDS Program, Department of Internal Medicine, All India Institute of Medical Sciences, New Delhi, 11029, India. sksharma@aiims.ac.in.

ABSTRACT

Background: In many developing countries, out-of-pocket payment remains a primary mechanism by which patients infected with HIV access treatment. In India, this has been changing as the National AIDS Control Organization (NACO) has been rolling out free antiretroviral therapy throughout the country since 2004. The vast majority of patients, however, remain without access to free medicines.

Methods: A retrospective chart review was performed on data obtained from a registry of ninety-three (93) patients attending a self-pay clinic at the All India Institute of Medical Sciences in Delhi, India. Multivariable Cox proportional hazard and logistic regression models were explored to assess the relationship between lost-to-follow-up status and the predictor variables: age, sex, household income, baseline CD4 count, and distance from clinic.

Results: Lost-to-follow-up rates were very high; 68% (63/93) were lost-to-follow-up till the time of chart review, including 59% (55/93) who were lost within one year. In both regression models, younger age, low baseline CD4 counts, and low income level were significantly associated with increased risk of lost-to-follow-up. Additionally, there was a significant interaction between income and CD4 counts. The patients with both low CD4 counts and low income level were more likely to be lost-to-follow-up than would be predicted by each covariable alone.

Conclusion: In this small cohort of AIDS patients attending a self-pay antiretroviral clinic at a large tertiary care center in Delhi, India, follow-up rates were quite poor. Poorer patients tended to present to clinic with more depressed CD4 counts and were less likely to be retained in care. These findings indicate that greater strides must be taken to improve the recruitment and retention of poor patients. The expansion of free antiretrovirals is one step among many necessary to achieve this objective.

No MeSH data available.


Related in: MedlinePlus