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Time-Dependent Predictors of Loss to Follow-Up in a Large HIV Treatment Cohort in Nigeria.

Meloni ST, Chang C, Chaplin B, Rawizza H, Jolayemi O, Banigbe B, Okonkwo P, Kanki P - Open Forum Infect Dis (2014)

Bottom Line: Factors associated with increased risk for LTFU were young age, having nonincome-generating occupations or no education, being unmarried, World Health Organization (WHO) stage, having a detectable viral load, and lower CD4(+) cell counts.In a subset analysis, adherence patterns during the first 3 months of ART were associated with risk of LTFU by month 12.In settings with limited resources, early adherence patterns, as well as CD4(+) cell counts and unsuppressed viral load, at any time point in treatment are predictive of loss and serve as effective markers for developing targeted interventions to reduce rates of attrition.

View Article: PubMed Central - PubMed

Affiliation: Harvard School of Public Health.

ABSTRACT

Background: Most evaluations of loss to follow-up (LTFU) in human immunodeficiency virus (HIV) treatment programs focus on baseline predictors, prior to antiretroviral therapy (ART) initiation. As risk of LTFU is a continuous issue, the aim of this evaluation was to augment existing information with further examination of time-dependent predictors of loss.

Methods: This was a retrospective evaluation of data collected between 2004 and 2012 by the Harvard School of Public Health and the AIDS Prevention Initiative in Nigeria as part of PEPFAR-funded program in Nigeria. We used multivariate modeling methods to examine associations between CD4(+) cell counts, viral load, and early adherence patterns with LTFU, defined as no refills collected for at least 2 months since the last scheduled appointment.

Results: Of 51 953 patients initiated on ART between 2004 and 2011, 14 626 (28%) were LTFU by 2012. Factors associated with increased risk for LTFU were young age, having nonincome-generating occupations or no education, being unmarried, World Health Organization (WHO) stage, having a detectable viral load, and lower CD4(+) cell counts. In a subset analysis, adherence patterns during the first 3 months of ART were associated with risk of LTFU by month 12.

Conclusions: In settings with limited resources, early adherence patterns, as well as CD4(+) cell counts and unsuppressed viral load, at any time point in treatment are predictive of loss and serve as effective markers for developing targeted interventions to reduce rates of attrition.

No MeSH data available.


Related in: MedlinePlus

CD4+ cell counts and viral loads predict LTFU in time-dependent manner. Abbreviations: ART, antiretroviral therapy; LTFU, loss to follow-up; VL, viral load.
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OFU055F2: CD4+ cell counts and viral loads predict LTFU in time-dependent manner. Abbreviations: ART, antiretroviral therapy; LTFU, loss to follow-up; VL, viral load.

Mentions: After finding that baseline CD4+ cell count was a significant predictor of LTFU, we wanted to determine whether CD4+ cell count remained a continuous predictor of loss. The median CD4+ cell counts (Fig. 2a) continually increased over the 4 years for both of the patients who were retained, as well as those who were not retained in the evaluated time period. For patients that were lost, the median of the last CD4+ cell count prior to loss, regardless of time of loss, was 183 cells/mL (IQR: 86–316 cells/mL). At each of the assessed time points, the median CD4+ cell count from the prior 6 months was higher in those subsequently retained compared to those LTFU (Fig. 2a). Similarly, we found that retained patients were more likely to be virally suppressed at their prior 6-month visit compared to those who were LTFU (Fig. 2b; P < 0.05); the median VL prior to loss in LTFU patients was 15 457 cp/mL (IQR: 200–143 386), where nearly 71% of patients had detectable viral load within the 6 months preceding loss regardless of time of loss.Fig. 2.


Time-Dependent Predictors of Loss to Follow-Up in a Large HIV Treatment Cohort in Nigeria.

Meloni ST, Chang C, Chaplin B, Rawizza H, Jolayemi O, Banigbe B, Okonkwo P, Kanki P - Open Forum Infect Dis (2014)

CD4+ cell counts and viral loads predict LTFU in time-dependent manner. Abbreviations: ART, antiretroviral therapy; LTFU, loss to follow-up; VL, viral load.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4281819&req=5

OFU055F2: CD4+ cell counts and viral loads predict LTFU in time-dependent manner. Abbreviations: ART, antiretroviral therapy; LTFU, loss to follow-up; VL, viral load.
Mentions: After finding that baseline CD4+ cell count was a significant predictor of LTFU, we wanted to determine whether CD4+ cell count remained a continuous predictor of loss. The median CD4+ cell counts (Fig. 2a) continually increased over the 4 years for both of the patients who were retained, as well as those who were not retained in the evaluated time period. For patients that were lost, the median of the last CD4+ cell count prior to loss, regardless of time of loss, was 183 cells/mL (IQR: 86–316 cells/mL). At each of the assessed time points, the median CD4+ cell count from the prior 6 months was higher in those subsequently retained compared to those LTFU (Fig. 2a). Similarly, we found that retained patients were more likely to be virally suppressed at their prior 6-month visit compared to those who were LTFU (Fig. 2b; P < 0.05); the median VL prior to loss in LTFU patients was 15 457 cp/mL (IQR: 200–143 386), where nearly 71% of patients had detectable viral load within the 6 months preceding loss regardless of time of loss.Fig. 2.

Bottom Line: Factors associated with increased risk for LTFU were young age, having nonincome-generating occupations or no education, being unmarried, World Health Organization (WHO) stage, having a detectable viral load, and lower CD4(+) cell counts.In a subset analysis, adherence patterns during the first 3 months of ART were associated with risk of LTFU by month 12.In settings with limited resources, early adherence patterns, as well as CD4(+) cell counts and unsuppressed viral load, at any time point in treatment are predictive of loss and serve as effective markers for developing targeted interventions to reduce rates of attrition.

View Article: PubMed Central - PubMed

Affiliation: Harvard School of Public Health.

ABSTRACT

Background: Most evaluations of loss to follow-up (LTFU) in human immunodeficiency virus (HIV) treatment programs focus on baseline predictors, prior to antiretroviral therapy (ART) initiation. As risk of LTFU is a continuous issue, the aim of this evaluation was to augment existing information with further examination of time-dependent predictors of loss.

Methods: This was a retrospective evaluation of data collected between 2004 and 2012 by the Harvard School of Public Health and the AIDS Prevention Initiative in Nigeria as part of PEPFAR-funded program in Nigeria. We used multivariate modeling methods to examine associations between CD4(+) cell counts, viral load, and early adherence patterns with LTFU, defined as no refills collected for at least 2 months since the last scheduled appointment.

Results: Of 51 953 patients initiated on ART between 2004 and 2011, 14 626 (28%) were LTFU by 2012. Factors associated with increased risk for LTFU were young age, having nonincome-generating occupations or no education, being unmarried, World Health Organization (WHO) stage, having a detectable viral load, and lower CD4(+) cell counts. In a subset analysis, adherence patterns during the first 3 months of ART were associated with risk of LTFU by month 12.

Conclusions: In settings with limited resources, early adherence patterns, as well as CD4(+) cell counts and unsuppressed viral load, at any time point in treatment are predictive of loss and serve as effective markers for developing targeted interventions to reduce rates of attrition.

No MeSH data available.


Related in: MedlinePlus