Characteristics and comprehensiveness of adult HIV care and treatment programmes in Asia‐Pacific, sub‐Saharan Africa and the Americas: results of a site assessment conducted by the International epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration

Duda, Stephany N.; Farr, Amanda M.; Lindegren, Mary Lou; Blevins, Meridith; Wester, Carolyn; Wools‐Kaloustian, Kara; Ekouévi, Didier K.; Egger, Matthias; Hemingway-Foday, Jennifer; Cooper, David A.; Moore, Richard D.; McGowan, Catherine C.; Nash, Denis

doi:10.7448/ias.17.1.19045

Cited by 46 publications

(44 citation statements)

References 33 publications

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“…Recently, there has been greater attention on reducing LTFU rates to ensure patients are retained in care, maintain adherence and achieve better long term outcomes 5,34 . Treatment programmes in Asia commonly conduct at least one form of outreach and tracking for adults receiving ART who have missed clinic visits 19 . Most report phone call as the method of contact, but other methods include sending letters, home visits, consulting with pharmacies and checking hospital records.…”

Section: Discussionmentioning

confidence: 99%

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Loss to Follow-up Trends in HIV-Positive Patients Receiving Antiretroviral Treatment in Asia From 2003 to 2013

Mata

Nguyen

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction Over time there has been substantial improvement in antiretroviral treatment (ART) programmes, including expansion of services and increased patient engagement. We describe time trends in, and factors associated with, loss to follow-up (LTFU) in HIV-positive patients receiving ART in Asia. Methods Analysis included HIV-positive adults initiating ART in 2003-2013 at seven ART programmes in Asia. Patients LTFU had not attended the clinic for ≥180 days, had not died or transferred to another clinic. Patients were censored at recent clinic visit, follow-up to January 2014. We used cumulative incidence to compare LTFU and mortality between years of ART initiation. Factors associated with LTFU were evaluated using a competing risks regression model, adjusted for clinical site. Results A total of 8,305 patients were included. There were 743 patients LTFU and 352 deaths over 26,217 person-years (pys), a crude LTFU and mortality rate of 2.83 (2.64-3.05) per 100 pys and 1.34 (1.21-1.49) per 100 pys, respectively. At 24 months, the cumulative LTFU incidence increased from 4.3%(2.9-6.1%) in 2003-05 to 8.1%(7.1-9.2%) in 2006-09, then decreased to 6.7%(5.9-7.5%) in 2010-13. Concurrently, the cumulative mortality incidence decreased from 6.2%(4.5-8.2%) in 2003-05 to 3.3%(2.8-3.9%) in 2010-13. The risk of LTFU reduced in 2010-13 compared to 2006-09 (adjusted subhazard ratio=0.73, 0.69-0.99). Conclusions LTFU rates in HIV-positive patients receiving ART in our clinical sites have varied by the year of ART initiation, with rates declining in recent years while mortality rates have remained stable. Further increases in site-level resources are likely to contribute to additional reductions in LTFU for patients initiating in subsequent years.

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Section: Discussionmentioning

confidence: 99%

“…Previous studies have highlighted that the use of support services offered by HIV programmes is associated with increased engagement in-case 18,19 . The HIV cascade of care describes how patients move between stages of care, from HIV diagnosis, to linkage and retention in care, to ART initiation and viral load suppression 20 .…”

Section: Introductionmentioning

confidence: 99%

Loss to Follow-up Trends in HIV-Positive Patients Receiving Antiretroviral Treatment in Asia From 2003 to 2013

Mata

Nguyen

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…There are seven regional data centres within IeDEA in North America (The North American AIDS Cohort Collaboration on Research and Design, NA-ACCORD), the Caribbean, Central and South America (CCASAnet), the Asia-Pacific (AP), and Africa (East Africa, EA; Central Africa, CA; West Africa, WA; Southern Africa, SnA) 3,4 . Currently, IeDEA includes data on more than one million people living with HIV/AIDS.…”

Section: Introductionmentioning

confidence: 99%

HIV Viral Load Suppression in Adults and Children Receiving Antiretroviral Therapy—Results From the IeDEA Collaboration

Jiamsakul

Kariminia

Althoff

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Having 90% of patients on antiretroviral therapy (ART) and achieving an undetectable viral load (VL) is one of the 90:90:90 by 2020 targets. In this global analysis, we investigated the proportions of adult and paediatric patients with VL suppression in the first three years after ART initiation. Methods Patients from the IeDEA cohorts who initiated ART between 2010 and 2014 were included. Proportions with VL suppression (<1000 copies/mL) were estimated using: (i) strict intention-to-treat (ITT) – loss to follow-up (LTFU) and dead patients counted as having detectable VL; and (ii) modified ITT – LTFU and dead patients were excluded. Logistic regression was used to identify predictors of viral suppression at one year after ART initiation using modified ITT. Results A total of 35561 adults from 38 sites/16 countries and 2601 children from 18 sites/6 countries were included. When comparing strict with modified ITT methods, the proportion achieving VL suppression at three years from ART initiation changed from 45.1% to 90.2% in adults, and 60.6% to 80.4% in children. In adults, older age, higher CD4 count pre-ART, and homosexual/bisexual HIV exposure were associated VL suppression. In children, older age and higher CD4 percentage pre-ART showed significant associations with VL suppression. Conclusions Large increases in the proportion of VL suppression in adults were observed when we excluded those who were LTFU or had died. The increases were less pronounced in children. Greater emphasis should be made to minimise LTFU and maximise patient retention in HIV-infected patients of all age groups.

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“…In developed countries, there are ample resources to provide optimal patient care, including HIV viral load monitoring, drug resistance testing and alternate ARV drugs, so ART regimens after first treatment failure can be accommodated. In resource-limited settings (RLS), patients have limited options due to drug affordability, minimal laboratory monitoring and ARV drug supply (Duda et al, 2014; Hirsch et al, 2008; Kumarasamy & Krishnan, 2013; Long, Fox, Sanne, & Rosen, 2010). Hence, the rate of switching from the first-line ART to the second ART is lower in resource-limited settings compared to developed countries (Group et al, 2009; Pujades-Rodriguez et al, 2010; Renaud-Thery et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

Growing challenges for HIV programmes in Asia: clinic population trends, 2003–2013

Mata¹,

Kumarasamy

et al. 2017

AIDS Care

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The scale-up of antiretroviral therapy (ART) has led to a substantial change in the clinical population of HIV-positive patients receiving care. We describe the temporal trends in the demographic and clinical characteristics of HIV-positive patients initiating ART in 2003–13 within an Asian regional cohort. All HIV-positive adult patients that initiated ART between 2003 and 2013 were included. We summarized ART regimen use, age, CD4 cell count, HIV viral load, and HIV-related laboratory monitoring rates during follow-up by calendar year. A total of 16 962 patients were included in the analysis. Patients in active follow-up increased from 695 patients at four sites in 2003 to 11,137 patients at eight sites in 2013. The proportion of patients receiving their second or third ART regimen increased over time (5% in 2003 to 29% in 2013) along with patients aged ≥50 years (8% in 2003 to 18% in 2013). Concurrently, CD4 monitoring has remained stable in recent years, whereas HIV viral load monitoring, although varied among the sites, is increasing. There have been substantial changes in the clinical and demographic characteristics of HIV-positive patients receiving ART in Asia. HIV programmes will need to anticipate the clinical care needs for their aging populations, expanded viral load monitoring, and, the eventual increase in second and third ART regimens that will lead to higher costs and more complex drug procurement needs.

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Characteristics and comprehensiveness of adult HIV care and treatment programmes in Asia‐Pacific, sub‐Saharan Africa and the Americas: results of a site assessment conducted by the International epidemiologic Databases to Evaluate AIDS (IeDEA) Collaboration

Cited by 46 publications

References 33 publications

Loss to Follow-up Trends in HIV-Positive Patients Receiving Antiretroviral Treatment in Asia From 2003 to 2013

Loss to Follow-up Trends in HIV-Positive Patients Receiving Antiretroviral Treatment in Asia From 2003 to 2013

HIV Viral Load Suppression in Adults and Children Receiving Antiretroviral Therapy—Results From the IeDEA Collaboration

Growing challenges for HIV programmes in Asia: clinic population trends, 2003–2013

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