Descriptive analysis of World Health Organization-recommended second-line antiretroviral treatment: A retrospective cohort data analysis

Gumede, Siphamandla B; Fischer, Alex; Venter, François; Lalla-Edward, Samanta Tresha

doi:10.7196/samj.2019.v109i12.013895

Cited by 8 publications

(25 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Eleven percent of patients on second line therapy had experienced attrition to care. This nding was in line with a study done in Rwanda( 14) and higher than the result of other studies (15,16,18,20,21). This variation is due to a difference in computing attrition, that is transferred out cases were included in previous studies but not in this study.…”

Section: Discussionsupporting

confidence: 91%

“…The present study shows that one in every ve patients on second line therapy failed to achieve viral re-suppression. This nding was in agreement with studies conducted in resource limited settings (12)(13)(14)(15)(16)(17) and higher than a study conducted in south Africa (18). This variation is due to a difference in viral load measurement classi cation.…”

Section: Discussionsupporting

confidence: 91%

“…Being ambulatory, bedridden and lower CD4 cell count at therapy switch had an increased risk of lost to follow up and death. This nding was consistent with the studies done in Ethiopia on patients on rst line therapy (14,15,17,27,32). Hence, accessing routine viral load monitoring for early diagnosis of treatment failure will increase the probability of patient retention on care, instead of waiting until immunological failure or clinical advancement.…”

Section: Discussionsupporting

confidence: 91%

“…Similarly, patients with virological failure while on second-line treatment were also an increases risk of attrition, which is supported by a retrospective cohort study done in south Africa (15).Virally suppressed patients would have a stable clinical condition, feel self-control, and had better perceived quality of life that prolongs the chance of staying on care. This result implies that conducting routine viral load monitoring had a key role in program evaluation besides showing the success of treatment.…”

Section: Discussionmentioning

confidence: 82%

See 3 more Smart Citations

Rate of Viral Re-Suppression and Retention To Care Among HIV Infected Patients on Second Line Antiretroviral Therapy at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia.

Wedajo

Degu

Deribew³

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: In Ethiopia, first line antiretroviral therapy failure is growing rapidly. However, unlike first line therapy, to date, very little is known about the outcomes of second line therapy. Thus, this study assessed the rate of viral re-suppression and retention to care and their predictors among HIV infected patients on second line therapy. Methods: A retrospective cohort study was conducted among 642 HIV infected patients on second line therapy at Dessie Comprehensive Specialized Hospital, northeast Ethiopia from October 2016 to November 2019. Proportional Cox regression model was computed to explore predictors of viral re-suppression (Viral load less than 1000 copies/mL) and attrition to care. Results: Out of 642 subjects, 19 (3%), 44(6.9%), 70(10.9%), and 509(79.3%) patients were lost to follow up, died, transferred out, and alive on care, respectively. Similarly, 82.39 % (79.24 - 85.16%) patients had achieved viral re-suppression, with 96 per 100-person year rate of re-suppression in 550.16 year follow up. Patients who switched timely to second line therapy were at a high rate of viral re-suppression than patients who delayed to switch [Adjusted Hazard Rate, AHR = 1.43 (95%CI: 1.17-1.74)]. Not having drug substitution history [AHR =1.25 (95%CI: 1.02-1.52)] was positively associated with viral re-suppression, in contrast, being on anti-TB treatment [AHR = 0.67 (95% CI: 0.49 – 0.91)] negatively associated with viral re-suppression. By excluding transferred out cases, 63 (11%, 95% CI: 9.6 – 13.8%) out of 572 patients were failed to retain on care with 7.1 per 100 person year rate of attrition in 887.25 year observation. Patients who were ambulatory or bedridden at the time of therapy switch were more at risk of attrition to care as compared with workable patients [Adjusted Hazard Rate, AHR= 2.61 (95% CI: 1.40-4.87]. Similarly, being not virally re-suppressed [AHR= 6.87 (95% CI: 3.86-12.23)], CD4 count < = 450 cells/mm3 [AHR= 2.61 (95% CI: 1.40-4.87] were also positively associated with attrition to care. Conclusions: A significant number of patients had failed to achieve viral re-suppression and to retain on care. Most identified factors related to patient monitoring. Hence, patient centered intervention should be strengthen, besides treatment switch.

show abstract

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 82%

See 2 more Smart Citations

Rate of Viral Re-Suppression and Retention To Care Among HIV Infected Patients on Second Line Antiretroviral Therapy at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia.

Wedajo

Degu

Deribew³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Previous studies revealed that viral re-suppression and retention to care among patients on second-line therapy was heterogeneous, which range from 41% 7 to 83.1% 8 and 64.7% 9 to 92.5%, 10 respectively. Further, even if a few studies were done previously, the viral cutoff point (400 [11][12][13][14][15] or 500 7,8 copies/mL) to define viral re-suppression was not in agreement with WHO-2016 consolidated guidelines (<1000 copies/ mL) 4,16 or patient treatment outcomes evaluated using immunological and clinical failure criteria. 17 Both methods did not show the amount of virus in the blood directly and low sensitive and positive predictive value.…”

Section: Introductionmentioning

confidence: 99%

Rate of Viral Re-Suppression and Retention to Care Among PLHIV on Second-Line Antiretroviral Therapy at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia: A Retrospective Cohort Study

Wedajo¹,

Degu²,

Deribew³

et al. 2021

HIV

View full text Add to dashboard Cite

Background: In Ethiopia, first-line antiretroviral therapy failure is growing rapidly. However, unlike first-line therapy, to date, very little is known about the outcomes of second-line therapy. Thus, this study assessed the rate of viral re-suppression and attrition to care and their predictors among people living with HIV on second-line therapy. Methods: A retrospective cohort study was conducted on 642 people living with HIV at Dessie Comprehensive Specialized Hospital from October 2016 to November 2019. A proportional Cox regression model was computed to explore predictors of viral resuppression (viral load less than 1000 copies/mL) and attrition to care. Results: Out of 642 subjects, 19 (3%), 44 (6.9%), 70 (10.9%), and 509 (79.3%) patients were lost to follow up, died, transferred out, and alive on care, respectively. Similarly, 82.39% (95% CI: 79.24-85.16%) of patients had achieved viral re-suppression, with 96 per 100 person-year rate of re-suppression. Patients who switched timely to second-line therapy were at a higher rate of viral re-suppression than delayed patients [adjusted hazard rate, AHR = 1.43 (95% CI: 1.17-1.74)]. Not having drug substitution history [AHR = 1.25 (95% CI: 1.02-1.52)] was positively associated with viral re-suppression. In contrast, being on anti-TB treatment [AHR = 0.67 (95% CI: 0.49-0.91)] had lower likelihood with viral resuppression. In the current study, attrition to care was 11% (95% CI: 8.7-13.9%). Ambulatory or bedridden patients were more at risk of attrition to care as compared with workable patients [AHR = 2.61 (95% CI: 1.40-4.87)]. Similarly, being not virally resuppressed [AHR = 6.87 (95% CI: 3.86-12.23)] and CD4 count ≤450 cells/mm 3 [AHR = 2.61 (95% CI: 1.40-4.87)] were also positively associated with attrition to care. Conclusion: A significant number of patients failed to achieve viral re-suppression and attrition from care. Most identified factors related to patient monitoring. Hence, patientcentered intervention should be strengthened, besides treatment switch.

show abstract

Men missing from the HIV care continuum in sub‐Saharan Africa: a meta‐analysis and meta‐synthesis

et al. 2022

View full text Add to dashboard Cite

Introduction:Men are missing along the HIV care continuum. However, the estimated proportions of men in sub-Saharan Africa meeting the UNAIDS 95-95-95 goals vary substantially between studies. We sought to estimate proportions of men meeting each of the 95-95-95 goals across studies in sub-Saharan Africa, describe heterogeneity, and summarize qualitative evidence on factors influencing care engagement. Methods: We systematically searched PubMed and Embase for peer-reviewed articles published between 1 January 2014 and 16 October 2020. We included studies involving men ≥15 years old, with data from 2009 onward, reporting on at least one 95-95-95 goal in sub-Saharan Africa. We estimated pooled proportions of men meeting these goals using DerSimonion-Laird random effects models, stratifying by study population (e.g. studies focusing exclusively on men who have sex with men vs. studies that did not), facility setting (healthcare vs. community site), region (eastern/southern Africa vs. western/central Africa), outcome measurement (e.g. threshold for viral load suppression), median year of data collection (before vs. during or after 2017) and quality criteria. Data from qualitative studies exploring barriers to men's HIV care engagement were summarized using meta-synthesis. Results and discussion: We screened 14,896 studies and included 129 studies in the meta-analysis, compiling data over the data collection period. Forty-seven studies reported data on knowledge of serostatus, 43 studies reported on antiretroviral therapy use and 74 studies reported on viral suppression. Approximately half of men with HIV reported not knowing their status (0.49 [95% CI, 0.41-0.58; range, 0.09-0.97]) or not being on treatment (0.58 [95% CI, 0.51-0.65; range, 0.07-0.97]), while over three-quarters of men achieved viral suppression on treatment (0.79 [95% CI, 0.77-0.81; range, 0.39-0.97]. Heterogeneity was high, with variation in estimates across study populations, settings and outcomes. The meta-synthesis of 40 studies identified three primary domains in which men described risks associated with engagement in HIV care: perceived social norms, health system challenges and poverty. Conclusions: Psychosocial and systems-level interventions that change men's perceptions of social norms, improve trust in and accessibility of the health system, and address costs of accessing care are needed to better engage men, especially in HIV testing and treatment.

show abstract

Descriptive analysis of World Health Organization-recommended second-line antiretroviral treatment: A retrospective cohort data analysis

Cited by 8 publications

References 16 publications

Rate of Viral Re-Suppression and Retention To Care Among HIV Infected Patients on Second Line Antiretroviral Therapy at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia.

Rate of Viral Re-Suppression and Retention To Care Among HIV Infected Patients on Second Line Antiretroviral Therapy at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia.

Rate of Viral Re-Suppression and Retention to Care Among PLHIV on Second-Line Antiretroviral Therapy at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia: A Retrospective Cohort Study

Men missing from the HIV care continuum in sub‐Saharan Africa: a meta‐analysis and meta‐synthesis

Contact Info

Product

Resources

About