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Factors Associated with Retention to Care in an HIV Clinic in Gabon, Central Africa.

Janssen S, Wieten RW, Stolp S, Cremers AL, Rossatanga EG, Klipstein-Grobusch K, Belard S, Grobusch MP - PLoS ONE (2015)

Bottom Line: This retrospective study reports outcomes and factors associated with retention to HIV care at a primary HIV clinic in Lambaréné, Gabon.Cox regression analysis was used to assess factors associated with respective outcomes.Documented tuberculosis was associated with increased risk of being LTFU (adjusted hazard ratio (aHR) 1.80, 95% confidence interval (95% CI) 1.05-3.11, P = 0.03), whereas early starting anti-retroviral therapy (ART) was associated with a decreased risk of LTFU (aHR 0.43, 95%CI 0.24-0.76, P = 0.004), as was confirmed by qualitative data.

View Article: PubMed Central - PubMed

Affiliation: Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Centre de Traitement Ambulatoire, Lambaréné, Gabon; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany; Clinical Infectious Diseases Research Initiative, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.

ABSTRACT

Background: Retention to HIV care is vital for patients' survival, to prevent onward transmission and emergence of drug resistance. Travelling to receive care might influence adherence. Data on the functioning of and retention to HIV care in the Central African region are limited.

Methods: This retrospective study reports outcomes and factors associated with retention to HIV care at a primary HIV clinic in Lambaréné, Gabon. Adult patients who presented to this clinic between January 2010 and January 2012 were included. Outcomes were retention in care (defined as documented show-up for clinical visits, regardless of delay) or LTFU (defined as a patient not retained in care; on ART or ART naïve, not returning to care during the study period with a patient delay for scheduled visits of more than 6 months), and mortality. Cox regression analysis was used to assess factors associated with respective outcomes. Qualitative data on reasons for LTFU were obtained from focus-group discussions.

Results: Of 223 patients included, 67.3% were female. The mean age was 40.5 (standard deviation 11.4) years and the median CD4 count 275 (interquartile range 100.5-449.5) cells/μL. In total, 34.1% were lost to follow up and 8.1% died. Documented tuberculosis was associated with increased risk of being LTFU (adjusted hazard ratio (aHR) 1.80, 95% confidence interval (95% CI) 1.05-3.11, P = 0.03), whereas early starting anti-retroviral therapy (ART) was associated with a decreased risk of LTFU (aHR 0.43, 95%CI 0.24-0.76, P = 0.004), as was confirmed by qualitative data.

Conclusions: Retention to HIV care in a primary clinic in Gabon is relatively poor and interventions to address this should be prioritized in the HIV program. Early initiation of ART might improve retention in care.

No MeSH data available.


Related in: MedlinePlus

Retention in HIV care.Kaplan Meier curves of retention in care (in days) of patients who started ART at doctor visit 1 or 2 versus patients who were enrolled in pre-ART care. Starting ART was associated with retention in HIV care (aHR 0.47, 95% CI 0.28–0.79, p = 0.004).
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pone.0140746.g002: Retention in HIV care.Kaplan Meier curves of retention in care (in days) of patients who started ART at doctor visit 1 or 2 versus patients who were enrolled in pre-ART care. Starting ART was associated with retention in HIV care (aHR 0.47, 95% CI 0.28–0.79, p = 0.004).

Mentions: Fig 2 shows the Kaplan Meier curves for retention in care comparing the patient groups that started ART at doctor visit 1 or 2 (n/N = 134/197) versus those enrolled in pre-ART care (n/N = 56/197). Median follow up time for the group who started ART was 414 (IQR 286–542) days, whereas the group who was enrolled in pre-ART care was followed up for a median of 358 (IQR 89–627) days, respectively. Starting ART was associated with retention in HIV care (aHR 0.47, 95% CI 0.28–0.79, p = 0.004).


Factors Associated with Retention to Care in an HIV Clinic in Gabon, Central Africa.

Janssen S, Wieten RW, Stolp S, Cremers AL, Rossatanga EG, Klipstein-Grobusch K, Belard S, Grobusch MP - PLoS ONE (2015)

Retention in HIV care.Kaplan Meier curves of retention in care (in days) of patients who started ART at doctor visit 1 or 2 versus patients who were enrolled in pre-ART care. Starting ART was associated with retention in HIV care (aHR 0.47, 95% CI 0.28–0.79, p = 0.004).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4608719&req=5

pone.0140746.g002: Retention in HIV care.Kaplan Meier curves of retention in care (in days) of patients who started ART at doctor visit 1 or 2 versus patients who were enrolled in pre-ART care. Starting ART was associated with retention in HIV care (aHR 0.47, 95% CI 0.28–0.79, p = 0.004).
Mentions: Fig 2 shows the Kaplan Meier curves for retention in care comparing the patient groups that started ART at doctor visit 1 or 2 (n/N = 134/197) versus those enrolled in pre-ART care (n/N = 56/197). Median follow up time for the group who started ART was 414 (IQR 286–542) days, whereas the group who was enrolled in pre-ART care was followed up for a median of 358 (IQR 89–627) days, respectively. Starting ART was associated with retention in HIV care (aHR 0.47, 95% CI 0.28–0.79, p = 0.004).

Bottom Line: This retrospective study reports outcomes and factors associated with retention to HIV care at a primary HIV clinic in Lambaréné, Gabon.Cox regression analysis was used to assess factors associated with respective outcomes.Documented tuberculosis was associated with increased risk of being LTFU (adjusted hazard ratio (aHR) 1.80, 95% confidence interval (95% CI) 1.05-3.11, P = 0.03), whereas early starting anti-retroviral therapy (ART) was associated with a decreased risk of LTFU (aHR 0.43, 95%CI 0.24-0.76, P = 0.004), as was confirmed by qualitative data.

View Article: PubMed Central - PubMed

Affiliation: Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Centre de Traitement Ambulatoire, Lambaréné, Gabon; Centre de Recherches Médicales de Lambaréné (CERMEL), Lambaréné, Gabon; Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany; Clinical Infectious Diseases Research Initiative, Institute for Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.

ABSTRACT

Background: Retention to HIV care is vital for patients' survival, to prevent onward transmission and emergence of drug resistance. Travelling to receive care might influence adherence. Data on the functioning of and retention to HIV care in the Central African region are limited.

Methods: This retrospective study reports outcomes and factors associated with retention to HIV care at a primary HIV clinic in Lambaréné, Gabon. Adult patients who presented to this clinic between January 2010 and January 2012 were included. Outcomes were retention in care (defined as documented show-up for clinical visits, regardless of delay) or LTFU (defined as a patient not retained in care; on ART or ART naïve, not returning to care during the study period with a patient delay for scheduled visits of more than 6 months), and mortality. Cox regression analysis was used to assess factors associated with respective outcomes. Qualitative data on reasons for LTFU were obtained from focus-group discussions.

Results: Of 223 patients included, 67.3% were female. The mean age was 40.5 (standard deviation 11.4) years and the median CD4 count 275 (interquartile range 100.5-449.5) cells/μL. In total, 34.1% were lost to follow up and 8.1% died. Documented tuberculosis was associated with increased risk of being LTFU (adjusted hazard ratio (aHR) 1.80, 95% confidence interval (95% CI) 1.05-3.11, P = 0.03), whereas early starting anti-retroviral therapy (ART) was associated with a decreased risk of LTFU (aHR 0.43, 95%CI 0.24-0.76, P = 0.004), as was confirmed by qualitative data.

Conclusions: Retention to HIV care in a primary clinic in Gabon is relatively poor and interventions to address this should be prioritized in the HIV program. Early initiation of ART might improve retention in care.

No MeSH data available.


Related in: MedlinePlus