Attrition rate and its predictors among adults receiving anti-retroviral therapy following the implementation of the “Universal Test and Treat strategy” at public health institutions in Northern Ethiopia. A retrospective follow-up study

Bantie, Berihun; Abate, Moges Wubneh; Nigat, Adane Birhanu; Birlie, Tekalign Amera; Dires, Tadila; Minuye, Tigabu; Kerebeh, Gashaw; Tiruneh, Chalie Marew; Moges, Natnael; Chanie, Ermias Sisay; Feleke, Dejen Getaneh; Mulu, Animut Tilahun; Demssie, Biruk; Fentie, Tigabinesh Assfaw; Abate, Melsew Dagne; Abate, Makda; Seid, Awole; Dessie, Getenet

doi:10.1016/j.heliyon.2022.e11527

Cited by 4 publications

(2 citation statements)

References 27 publications

(64 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Advanced HIV disease, pregnancy and breastfeeding and earlier ART initiation (within one week after HIV diagnosis, compared to later) were associated with attrition across before and after “Treat All” cohorts. Advanced HIV and rapid ART initiation as risk factors for attrition have been reported elsewhere in the post- “Treat all”- era [ 57 ]. One study found a reduction (but not annulation) of pregnancy and breastfeeding as a risk factor for attrition after “Treat All” [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Attrition one year after starting antiretroviral therapy before and after the programmatic implementation of HIV “Treat All” in Sub-Saharan Africa: a systematic review and meta-analysis

Makurumidze,

Decroo,

Jacobs

et al. 2023

BMC Infect Dis

View full text Add to dashboard Cite

Introduction Evidence on the real-world effects of “Treat All” on attrition has not been systematically reviewed. We aimed to review existing literature to compare attrition 12 months after antiretroviral therapy (ART) initiation, before and after “Treat All” was implemented in Sub-Saharan Africa and describe predictors of attrition. Methods We searched Embase, Google Scholar, PubMed, and Web of Science in July 2020 and created alerts up to the end of June 2023. We also searched for preprints and conference abstracts. Two co-authors screened and selected the articles. Risk of bias was assessed using the modified Newcastle–Ottawa Scale. We extracted and tabulated data on study characteristics, attrition 12 months after ART initiation, and predictors of attrition. We calculated a pooled risk ratio for attrition using random-effects meta-analysis. Results Eight articles and one conference abstract (nine studies) out of 8179 screened records were included in the meta-analysis. The random-effects adjusted pooled risk ratio (RR) comparing attrition before and after “Treat All” 12 months after ART initiation was not significant [RR = 1.07 (95% Confidence interval (CI): 0.91–1.24)], with 92% heterogeneity (I2). Being a pregnant or breastfeeding woman, starting ART with advanced HIV, and starting ART within the same week were reported as risk factors for attrition both before and after “Treat All”. Conclusions We found no significant difference in attrition before and after “Treat All” one year after ART initiation. While “Treat All” is being implemented widely, differentiated approaches to enhance retention should be prioritised for those subgroups at risk of attrition. PROSPERO number CRD42020191582.

show abstract

Section: Discussionmentioning

confidence: 99%

Attrition one year after starting antiretroviral therapy before and after the programmatic implementation of HIV “Treat All” in Sub-Saharan Africa: a systematic review and meta-analysis

Makurumidze,

Decroo,

Jacobs

et al. 2023

BMC Infect Dis

View full text Add to dashboard Cite

show abstract

“…These LTFU rates were substantially higher than rates in adults, which ranged from 10.8% to 38% [ 14 , 15 , 16 , 17 , 18 ]. Other studies have shown reductions in LTFU among those >18 years after the implementation of rapid ART policies, and youth living with HIV (YLHIV) aged between 15 and 24 years were at higher risk of attrition compared to adults living with HIV [ 19 , 20 , 21 , 22 , 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Long‐term outcomes of rapid antiretroviral NNRTI‐based initiation among Thai youth living with HIV: a national registry database study

et al. 2023

View full text Add to dashboard Cite

Introduction The Thai National AIDS programme (NAP) treatment guidelines have recommended rapid antiretroviral therapy (ART) initiation, regardless of CD4 count since 2014. We assessed treatment outcomes among youth living with HIV (YLHIV), initiating first‐line ART and assessed the association between virological failure (VF) and timing of ART initiation. Methods We retrospectively reviewed data for YLHIV aged 15–24 years, initiating non‐nucleoside reverse transcriptase inhibitor‐based ART from 2014 to 2019, through the NAP database. We classified the timing of ART into three groups based on duration from HIV‐positive diagnosis or system registration to ART initiation: (1) <1 month (rapid ART); (2) 1–3 months (intermediate ART); and (3) >3 months (delayed ART). VF was defined as viral load (VL) ≥ 1000 copies/ml after at least 6 months of first‐line ART. Factors associated with VF were analysed using generalized estimating equations. Results Of 19,825 YLHIV who started ART, 78% were male. Median (interquartile range, IQR) age was 21 (20–23) years and CD4 count was 338 (187–498) cells/mm3. After registration, 12,216 (62%) started rapid ART, 4272 (22%) intermediate ART and 3337 (17%) delayed ART. The proportion of YLHIV starting ART <30 days significantly increased from 43% to 57% from 2014–2016 to 2017–2019 (p < 0.001). The median duration of first‐line therapy was 2 (IQR 1–3) years and 89% started with efavirenz‐based regimens. Attrition outcomes showed that 325 (2%) died (0.73 [95% CI 0.65–0.81] per 100 person‐years [PY]) and 1762 (9%) were loss to follow‐up (3.96 [95% CI 3.78–4.15] per 100 PY). Of 17,512 (88%) who had VL checked from 6 to 12 months after starting treatment, 80% achieved VL <200 copies/ml. Overall, 2512 experienced VF 5.87 (95% CI 5.65–6.11) per 100 PY). In a multivariate model, the adjusted incidence rate ratio for VF was 1.47 (95% CI 1.33–1.63, p < 0.001) in the delayed ART group and 1.14 (95% CI 1.03–1.25, p< 0.001) in the intermediate ART group, compared to YLHIV in the rapid ART group. Conclusions Rapid ART initiation after diagnosis was associated with significantly reduced risks of VF and death in YLHIV, supporting the implementation of rapid ART for optimizing health outcomes.

show abstract

Loss to Follow-up and Death Among Individuals With Newly Diagnosed Human Immunodeficiency Virus Receiving Dolutegravir-Based First-Line Antiretroviral Treatment in Eastern Ethiopia: Implications for 95% United Nations Targets

Gemechu,

Mihret,

Aseffa

et al. 2023

Open Forum Infectious Diseases

View full text Add to dashboard Cite

Background Loss-to-follow-up (LTFU) and mortality are unfavorable outcomes of HIV treatment. This study aimed to identify the predictors of LTFU and mortality among individuals newly diagnosed with HIV receiving dolutegravir (DTG)-based first-line antiretroviral treatment (ART) in eastern Ethiopia. Methods A multisite prospective cohort study was carried out between October 2020 and July 2022. New cases who started ART were enrolled consecutively, and then followed for the next six months. A structured questionnaire and checklists were used to collect data. HIV viral load test was done using the Abbott RealTime HIV-1 assay. Bi-variable and multivariable logistic regression models were used to identify baseline factors associated with the outcomes. Results 235 newly diagnosed people with HIV (PWH) were enrolled; 16.6% (95% CI =12.3–21.9%) were lost to follow-up, and 5.9% (95% CI =3.5–9.8%) died within six months of follow-up. Baseline WHO clinical stage I (AOR =3.93, 95% CI: 1.34–11.57), low viral load (AOR =3.67, 95% CI: 1.09–12.36), and body weight (AOR =1.04, 95% CI: 1.01–1.07) were predictors of LTFU, whereas non-functional status (AOR =10.02, 95% CI: 1.9–51.3) was the only factor associated with death. Conclusion LTFU and death rates among patients with DTG were relatively high, accounting for roughly a quarter of the attrition of newly diagnosed PWH from ART care and services. Thus, targeted interventions are required to reduce LTFU and death among individuals with HIV on ART. Further investigation is necessary to evaluate the long-term effects of DTG-based regimens on LTFU and its impact on HIV mortality, and qualitative research, specifically tracing LTFU patients, is recommended.

show abstract

Attrition rate and its predictors among adults receiving anti-retroviral therapy following the implementation of the “Universal Test and Treat strategy” at public health institutions in Northern Ethiopia. A retrospective follow-up study

Cited by 4 publications

References 27 publications

Attrition one year after starting antiretroviral therapy before and after the programmatic implementation of HIV “Treat All” in Sub-Saharan Africa: a systematic review and meta-analysis

Attrition one year after starting antiretroviral therapy before and after the programmatic implementation of HIV “Treat All” in Sub-Saharan Africa: a systematic review and meta-analysis

Long‐term outcomes of rapid antiretroviral NNRTI‐based initiation among Thai youth living with HIV: a national registry database study

Loss to Follow-up and Death Among Individuals With Newly Diagnosed Human Immunodeficiency Virus Receiving Dolutegravir-Based First-Line Antiretroviral Treatment in Eastern Ethiopia: Implications for 95% United Nations Targets

Contact Info

Product

Resources

About