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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

Time to death.Kaplan Meier curves of time to mortality (in days) of patients who started ART versus patients who did not start ART during the first 2 visits to the clinic. There was a trend towards a reduced mortality in patients who started ART.
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pone.0140746.g003: Time to death.Kaplan Meier curves of time to mortality (in days) of patients who started ART versus patients who did not start ART during the first 2 visits to the clinic. There was a trend towards a reduced mortality in patients who started ART.

Mentions: Fig 3 shows the Kaplan Meier curves for mortality comparing the groups that started ART versus those who did not start. Median time to mortality for the group who started ART was 317 days (range 156–654 days) whereas the group who did not start ART deceased after a median of 67 days (range 0–288 days). Initiation of ART at the 1st or 2nd doctor visit was associated with reduced mortality (cHR 0.38, 95% CI 0.15–0.95, p = 0.04). This did not remain significant in multivariate analysis, probably due to the small sample size (Table 3).


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)

Time to death.Kaplan Meier curves of time to mortality (in days) of patients who started ART versus patients who did not start ART during the first 2 visits to the clinic. There was a trend towards a reduced mortality in patients who started ART.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0140746.g003: Time to death.Kaplan Meier curves of time to mortality (in days) of patients who started ART versus patients who did not start ART during the first 2 visits to the clinic. There was a trend towards a reduced mortality in patients who started ART.
Mentions: Fig 3 shows the Kaplan Meier curves for mortality comparing the groups that started ART versus those who did not start. Median time to mortality for the group who started ART was 317 days (range 156–654 days) whereas the group who did not start ART deceased after a median of 67 days (range 0–288 days). Initiation of ART at the 1st or 2nd doctor visit was associated with reduced mortality (cHR 0.38, 95% CI 0.15–0.95, p = 0.04). This did not remain significant in multivariate analysis, probably due to the small sample size (Table 3).

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