Purpose
Interruptions in HIV care are a major cause of morbidity and
mortality, particularly in resource-limited settings. We compared engagement
in care and virologic outcomes between HIV-infected adolescents and young
adults (AYA) and older adults (OA) one year after starting antiretroviral
therapy (ART) in Nigeria.
Methods
We conducted a retrospective cohort study of AYA (15–24
years) and OA (>24 years) who initiated ART from 2009–2011.
We used negative binomial regression to model the risk of inconsistent care
and viremia (HIV RNA >1,000 copies/mL) among AYA and OA in the first
year on ART. Regular care included monthly ART pick-up and 3-monthly
clinical visits. Patients with ≤3 months between consecutive visits
were considered in care. Those with
inconsistent care had
>3 months between consecutive visits.
Results
The cohort included 354 AYA and 2,140 OA. More AYA than OA were
female (89% vs. 65%, p<0.001). Median baseline CD4
was 252/µL in AYA and 204/µL in OA (p=0.002). More AYA had
inconsistent care than OA (55% vs. 47%, p=0.001). Adjusting
for sex, baseline CD4, and education, AYA had a greater risk of inconsistent
care than OA (RR 1.11, p=0.033). Among those in care after one year on ART,
viremia was more common in AYA than OA (40% vs. 26% p=0.003,
RR 1.53, p=0.002).
Conclusions
In a Nigerian cohort, AYA were at increased risk for inconsistent HIV
care. Of patients remaining in care, youth was the only independent
predictor of viremia at 1 year. Youth-friendly models of HIV care are needed
to optimize health outcomes.
BackgroundUnplanned care interruption (UCI) challenges effective HIV treatment. We determined the frequency and risk factors for UCI in Nigeria.MethodsWe conducted a retrospective-cohort study of adults initiating antiretroviral therapy (ART) between January 2009 and December 2011. At censor, patients were defined as in care, UCI, or inactive. Associations between baseline factors and UCI rates were quantified using Poisson regression.ResultsAmong 2,496 patients, 44 % remained in care, 35 % had ≥1 UCI, and 21 % became inactive. UCI rates were higher in the first year on ART (39/100PY), than the second (19/100PY), third (16/100PY), and fourth (14/100PY) years (p < 0.001). In multivariate analysis, baseline CD4 > 350/uL (IRR 3.21, p < 0.0001), being a student (IRR 1.95, p < 0.0001), and less education (IRR 1.58, p = 0.001) increased risk for UCI. Fifty-five percent of patients with UCI and viral load data had HIV viral load > 1,000 copies/ml upon return to care.DiscussionUCI were observed in over one-third of patients treated, and were most common in the first year on ART. High baseline CD4 count at ART initiation was the greatest predictor of subsequent UCI.ConclusionsInterventions focused on the first year on ART are needed to improve continuity of HIV care.
In this Nigerian cohort, MPRs were high overall, and there was a strong association between low MPR and risk of VF. Nonetheless, 26% of AYA with high MPRs still had VF. Understanding the discrepancy between MPR and viral suppression in AYA is an important priority.
The authors conducted a retrospective cohort study of unplanned care interruption (UCI) among adults initiating antiretroviral therapy (ART) from 2009 to 2011 in a Nigerian clinic. The authors used repeated measures regression to model the impact of UCI on CD4 count upon return to care and rate of CD4 change on ART. Among 2496 patients, 83% had 0, 15% had 1, and 2% had ≥2 UCIs. Mean baseline CD4 for those with 0, 1, or ≥2 UCIs was 228/cells/mm 3 , 355/cells/mm 3 , and 392/cells/mm 3 (P < .0001), respectively. The UCI was associated with a 62 CD4 cells/mm 3 decrease (95% confidence interval [CI]: −78 to −45) at next measurement. In months 1 to 6 on ART, patients with 0 UCI gained 10 cells/μL/mo (95% CI: 7-4). Those with 1 and ≥2 UCIs lost 2
Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
HHS Public Access
Background Global HIV funding cutbacks have been accompanied by the adoption of user fees to address funding gaps in treatment programs. Our objective was to assess the impact of user fees on HIV care utilization and medication adherence in Nigeria. Methods We conducted a retrospective analysis of patients enrolled in care before (October 2012-September 2013) and after (October 2014-September 2015) the introduction of user fees in a Nigerian clinic. We assessed pre-vs. post-user fee patient characteristics and enrollment trends, and determined risk of care interruption, loss to follow-up, and optimal medication adherence. Results After fees were instituted, there was a 66% decline in patient enrollment and 75% decline in number of ART doses dispensed. There was no difference in the proportion of female clients (64% vs 63%, p = 0.46), average age (36 vs. 37 years, p = 0.15), or median baseline CD4 (220/ul vs. 222/uL, p = 0.24) in pre-and post-fee cohorts. There was an increase in clients employed and/or had tertiary education (24% vs. 32%, p<0.001). Compared to pre-fee
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