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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

Kaplan-Meier survival curve of retention in HIV care by quartiles of CD4 cell count (cells/μL) at the start of cART, Addis Ababa, 2013 (n = 836).
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pone.0130649.g002: Kaplan-Meier survival curve of retention in HIV care by quartiles of CD4 cell count (cells/μL) at the start of cART, Addis Ababa, 2013 (n = 836).

Mentions: Of the total 828 patients with a recorded CD4 cell count at the start of cART, 57 had died or become LTFU in quartile 1 (≤72 CD4 cells/μL), 36 in quartile 2 (73–133 CD4 cells/μL), 28 in quartile 3 (134–202 CD4 cells/μL), and 26 in quartile 4 (≥203 CD4 cells/μL). The Kaplan-Meier survival curve in Fig 2 –Kaplan-Meier survival curve of retention in HIV care by quartiles of CD4 cell count (cells/μL) at the start of cART—shows that patients who started cART in quartiles 4, 3, and 2 appeared more likely to be retained in care than patients in quartile 1 (log-rank Chi-sq statistic = 30.8, df = 3, p-value <0.001). In addition, patients with ‘bed-ridden’ or ‘ambulatory’ functional status at start cART had significantly lower probability of being retained in care than patients with a ‘working’ functional status (log-rank Chi-sq statistic = 24.53, df = 2, p-value <0.001; Fig 3 –Kaplan-Meier survival curve for retention in HIV care by functional status at the start of cART).


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)

Kaplan-Meier survival curve of retention in HIV care by quartiles of CD4 cell count (cells/μL) at the start of cART, Addis Ababa, 2013 (n = 836).
© Copyright Policy
Related In: Results  -  Collection

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

pone.0130649.g002: Kaplan-Meier survival curve of retention in HIV care by quartiles of CD4 cell count (cells/μL) at the start of cART, Addis Ababa, 2013 (n = 836).
Mentions: Of the total 828 patients with a recorded CD4 cell count at the start of cART, 57 had died or become LTFU in quartile 1 (≤72 CD4 cells/μL), 36 in quartile 2 (73–133 CD4 cells/μL), 28 in quartile 3 (134–202 CD4 cells/μL), and 26 in quartile 4 (≥203 CD4 cells/μL). The Kaplan-Meier survival curve in Fig 2 –Kaplan-Meier survival curve of retention in HIV care by quartiles of CD4 cell count (cells/μL) at the start of cART—shows that patients who started cART in quartiles 4, 3, and 2 appeared more likely to be retained in care than patients in quartile 1 (log-rank Chi-sq statistic = 30.8, df = 3, p-value <0.001). In addition, patients with ‘bed-ridden’ or ‘ambulatory’ functional status at start cART had significantly lower probability of being retained in care than patients with a ‘working’ functional status (log-rank Chi-sq statistic = 24.53, df = 2, p-value <0.001; Fig 3 –Kaplan-Meier survival curve for retention in HIV care by functional status at the start of cART).

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