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Retention in HIV Care and Predictors of Attrition from Care among HIV-Infected Adults Receiving Combination Anti-Retroviral Therapy in Addis Ababa.

Mekuria LA, Prins JM, Yalew AW, Sprangers MA, Nieuwkerk PT - PLoS ONE (2015)

Bottom Line: After successfully tracing more than half of the LTFU patients, the updated one year retention in care estimate became 86% (95% CI: 83.41%, 88.17%).Retention in HIV care in Addis Ababa is comparable with or even better than previous findings from other resource-limited as well as EU/USA settings.However, measures to detect and enroll patients in HIV care as early as possible are still necessary.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Epidemiology, Netherlands Institute for Health Sciences/Erasmus University Medical Center, Rotterdam, The Netherlands; School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.

ABSTRACT

Background: Patient retention in chronic HIV care is a major challenge following the rapid expansion of combination antiretroviral therapy (cART) in Ethiopia.

Objective: To describe the proportion of patients who are retained in HIV care and characterize predictors of attrition among HIV-infected adults receiving cART in Addis Ababa.

Method: A retrospective analysis was conducted among 836 treatment naïve patients, who started cART between May 2009 and April 2012. Patients were randomly selected from ten health-care facilities, and their current status in HIV care was determined based on routinely available data in the medical records. Patients lost to follow-up (LTFU) were traced by telephone. Kaplan-Meier technique was used to estimate survival probabilities of retention and Cox proportional hazards regression was performed to identify the predictors of attrition.

Results: Based on individual patient data from the medical records, nearly 80% (95%CI: 76.7, 82.1) of the patients were retained in care in the first 3 and half years of antiretroviral therapy. After successfully tracing more than half of the LTFU patients, the updated one year retention in care estimate became 86% (95% CI: 83.41%, 88.17%). In the multivariate Cox regression analyses, severe immune deficiency at enrolment in care/or at cART initiation and 'bed-ridden' or 'ambulatory' functional status at the start of cART predicted attrition.

Conclusion: Retention in HIV care in Addis Ababa is comparable with or even better than previous findings from other resource-limited as well as EU/USA settings. However, measures to detect and enroll patients in HIV care as early as possible are still necessary.

No MeSH data available.


Related in: MedlinePlus

Flowchart depicting the random selection of health care facilities and patients included in the study.
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pone.0130649.g001: Flowchart depicting the random selection of health care facilities and patients included in the study.

Mentions: This study was conducted between September 2012 and April 2013 in ten randomly selected health care facilities that had started providing adult cART service as of January 1, 2009 or before in Addis Ababa, Ethiopia. At the time of the study, HIV-infected adults who fulfilled the following World Health Organization (WHO) criteria were automatically eligible for cART once their readiness to initiate anti-retroviral therapy was assured: WHO clinical stage IV, irrespective of CD4 cell count; WHO clinical stage III with a CD4 cell count of ≤350/mm3; all WHO clinical stages with CD4 cell counts ≤200/mm3 [20]. Patients eligible to participate were selected in a two-step procedure using the national ART register as a sampling frame. First, we selected all adult HIV-infected persons without previous exposure to cART—except for the prevention of mother to child transmission—who initiated cART between May 1, 2009 and April 30, 2012. Patients who had been transferred-in or formally transferred-out after initiating cART were excluded. Second, out of these patients, we selected every 8th patient from the ART register using a systematic random sampling technique. Fig 1—Flowchart depicting the random selection of health care facilities and patients included in the study—illustrates the selection process.


Retention in HIV Care and Predictors of Attrition from Care among HIV-Infected Adults Receiving Combination Anti-Retroviral Therapy in Addis Ababa.

Mekuria LA, Prins JM, Yalew AW, Sprangers MA, Nieuwkerk PT - PLoS ONE (2015)

Flowchart depicting the random selection of health care facilities and patients included in the study.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4482764&req=5

pone.0130649.g001: Flowchart depicting the random selection of health care facilities and patients included in the study.
Mentions: This study was conducted between September 2012 and April 2013 in ten randomly selected health care facilities that had started providing adult cART service as of January 1, 2009 or before in Addis Ababa, Ethiopia. At the time of the study, HIV-infected adults who fulfilled the following World Health Organization (WHO) criteria were automatically eligible for cART once their readiness to initiate anti-retroviral therapy was assured: WHO clinical stage IV, irrespective of CD4 cell count; WHO clinical stage III with a CD4 cell count of ≤350/mm3; all WHO clinical stages with CD4 cell counts ≤200/mm3 [20]. Patients eligible to participate were selected in a two-step procedure using the national ART register as a sampling frame. First, we selected all adult HIV-infected persons without previous exposure to cART—except for the prevention of mother to child transmission—who initiated cART between May 1, 2009 and April 30, 2012. Patients who had been transferred-in or formally transferred-out after initiating cART were excluded. Second, out of these patients, we selected every 8th patient from the ART register using a systematic random sampling technique. Fig 1—Flowchart depicting the random selection of health care facilities and patients included in the study—illustrates the selection process.

Bottom Line: After successfully tracing more than half of the LTFU patients, the updated one year retention in care estimate became 86% (95% CI: 83.41%, 88.17%).Retention in HIV care in Addis Ababa is comparable with or even better than previous findings from other resource-limited as well as EU/USA settings.However, measures to detect and enroll patients in HIV care as early as possible are still necessary.

View Article: PubMed Central - PubMed

Affiliation: Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Epidemiology, Netherlands Institute for Health Sciences/Erasmus University Medical Center, Rotterdam, The Netherlands; School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.

ABSTRACT

Background: Patient retention in chronic HIV care is a major challenge following the rapid expansion of combination antiretroviral therapy (cART) in Ethiopia.

Objective: To describe the proportion of patients who are retained in HIV care and characterize predictors of attrition among HIV-infected adults receiving cART in Addis Ababa.

Method: A retrospective analysis was conducted among 836 treatment naïve patients, who started cART between May 2009 and April 2012. Patients were randomly selected from ten health-care facilities, and their current status in HIV care was determined based on routinely available data in the medical records. Patients lost to follow-up (LTFU) were traced by telephone. Kaplan-Meier technique was used to estimate survival probabilities of retention and Cox proportional hazards regression was performed to identify the predictors of attrition.

Results: Based on individual patient data from the medical records, nearly 80% (95%CI: 76.7, 82.1) of the patients were retained in care in the first 3 and half years of antiretroviral therapy. After successfully tracing more than half of the LTFU patients, the updated one year retention in care estimate became 86% (95% CI: 83.41%, 88.17%). In the multivariate Cox regression analyses, severe immune deficiency at enrolment in care/or at cART initiation and 'bed-ridden' or 'ambulatory' functional status at the start of cART predicted attrition.

Conclusion: Retention in HIV care in Addis Ababa is comparable with or even better than previous findings from other resource-limited as well as EU/USA settings. However, measures to detect and enroll patients in HIV care as early as possible are still necessary.

No MeSH data available.


Related in: MedlinePlus