Characterizing retention in HAART as a recurrent event process

Abstract

Objective The benefits of HAART rely on continuous lifelong treatment retention. We used linked population-level health administrative data to characterize durations of HAART retention and nonretention. Design This is a retrospective cohort study. Methods We considered individuals initiating HAART in British Columbia (1996–2012). An HAART episode was considered discontinued if individuals had a gap of at least 30 days between days in which medication was prescribed. We considered durations of HAART retention and nonretention separately, and used Cox proportional hazards frailty models to identify demographic and treatment-related factors associated with durations of HAART retention and nonretention. Results Six thousand one hundred fifty-two individuals were included in the analysis; 81.2% were male, 40.6% were people who inject drugs, and 42.8% initiated treatment with CD4 cell count less than 200 cells/μl. Overall, 29% were continuously retained on HAART through the end of follow-up. HAART episodes were a median 6.8 months (25th, 75th percentile: 2.3, 19.5), whereas off-HAART episodes lasted a median 1.9 months (1.2, 4.5). In Cox proportional hazards frailty models, durations of HAART retention improved over time. Successive treatment episodes tended to decrease in duration among those with multiple attempts, whereas off-HAART episodes remained relatively stable. Younger age, earlier stages of disease progression, and injection drug use were all associated with shorter durations of HAART retention and longer off-HAART durations. Conclusion Metrics to monitor HAART retention, dropout, and reentry should be prioritized for HIV surveillance. Clinical strategies and public health policies are urgently needed to improve HAART retention, particularly among those at earlier stages of disease progression, the young, and people who inject drugs.

Predictors of Adult Retention in HIV Care: A Systematic Review

“…Of the 30 remaining, all listed retention in care as a dependent/outcome variable. One study, Noysk et al [12], operationalized retention in care as the duration of episodes on or off HARRT as defined by pharmacy dispensing records. While this is associated with medication, it does not relate to adherence per se but instead explores medication dispensing which is consistent with other measures of retention.…”

“…Noysk et al [12] noted that intravenous drug use (IVDU) in particular was associated with poor retention, while Rebeiro et al [17] noted that those within the IVDU HIV transmission risk group were more likely, than their non-IVDU counterparts, to dropout of care. Tobias et al [10] identified that those classified as receiving “no care” (i.e.…”

Patients who restart antiretroviral medication after interruption remain at high risk of unfavorable outcomes in Ethiopia

“…These may be related to lack of access to care and support programs, distance from treatment site, advanced disease stage, or lack of proper adherence counseling [14, 15]. A study in British Columbia [16] describes a slightly different trend in treatment interruption experiences. In this setting, only 29% of patients were active on treatment continuously, though the follow-up period was longer than the current study (1996–2012).…”

Antiretroviral Therapy Interruption Among HIV Postive People Who Use Drugs in a Setting with a Community-Wide HIV Treatment-as-Prevention Initiative

“…We purposefully sampled ACCESS participants who had not filled an ART prescription for a period of at least 30 days (consistent with previous analyses of ART interruptions in this setting [19]) between January 2011 and December 2012. This observation period was chosen to minimize biases due to poor recall of events.…”

“…Accordingly, ART interruptions (defined as ≥30 consecutive days without taking ART [19]) undermine the effectiveness of TasP by prompting viral load rebound [20, 21], thereby increasing the risk of HIV-related morbidity, onward HIV transmission, and the development of viral drug resistance [22, 23]. Despite the beneficial impact of optimal adherence to treatment on disease outcomes, ART interruptions remain common among some key populations, particularly people who use drugs (PWUD) [24–26].…”