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

Abstract

BackgroundAchieving optimal adherence to highly active antiretroviral therapy (HAART) is necessary to attain viral suppression and hence optimal clinical outcome. Interruptions in antiretroviral therapy medication often occur, but a substantial proportion restart treatment. Long-term care engagement practices and clinical outcomes have not been described among cohorts of individuals on HAART in Ethiopia.MethodsIn this study we describe treatment interruption patterns over time among clients who interrupt and subsequently resume HAART, and those who are continuously engaged in treatment, and determine clinical factors associated with loss to engagement.An observational, longitudinal, retrospective cohort design was engaged, using secondary treatment program data. We analyzed differences in treatment interruption among clients who were continuously active and those that interrupted and restarted treatment at months 6, 12, 18, and 24. Cox proportional hazards regression analysis was used to identify predictors of loss from treatment. We estimated time to first treatment interruption, time to restarting after interruption, and time to second interruption. Data from all clients registered to receive HAART in ten study health facilities, from 2005 to 2014, were used to study clinical and treatment outcomes up to 60 months or study end.ResultsIn this study, 39% (8,759/22,647) of clients interrupted treatment for more than 1 month at least at one point during follow-up. Of these, only 35% ever restarted treatment. At the end of follow-up, the hazard of unfavorable treatment outcome (dead, lost, stopped HAART) for clients who restarted treatment at months 6, 12, 18 and 24 was higher by a factor of 1.9, 2.4, 2.6 and 2.4, as compared to those who never discontinued treatment at those times.ConclusionHAART treatment interruption was common in the study population. In those with a history of treatment interruption, long term clinical outcomes were found to be suboptimal. Targeted interventions are required to address follow-up challenges and prevent treatment interruption.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2172-9) contains supplementary material, which is available to authorized users.

What causes non-adherence among some individuals on long term antiretroviral therapy? Experiences of individuals with poor viral suppression in Uganda

“…A systematic review of individual and contextual factors affecting retention and adherence among pregnant and post-partum women living with HIV found that religious beliefs and use of alternative medicines discouraged ART adherence [16]. Similar findings have been reported from other studies involving different populations [17–19]. Other systematic reviews of barriers to ART adherence in developing and developed countries showed that the fear to disclose HIV status, treatment suspicion together with the desire to avoid taking medication in public places among others, negatively affected adherence [20, 21].…”

“…There are contrasting reports on the association between duration on ART and adherence. Whereas some studies have reported decreasing adherence with increasing duration on ART [2, 14, 17, 21, 28–31], others have reported an increase in adherence as people stay longer on ART [29, 32–36].…”

Factors associated with unfavourable treatment outcomes in people with HIV-associated tuberculosis in Armenia, 2015 to 2019

“…We also found that ART interruption during TB treatment increased the risk of unfavourable TB treatment outcome. Literature shows that ART interruptions are associated with a decrease in CD4 cell count, increase in viral load and development of opportunistic infections [22,23]. Even though TB meningitis was a rare event in our cohort, it was significantly associated with an increased risk of unfavourable TB treatment outcome and death.…”

Measuring patient engagement with HIV care in sub‐Saharan Africa: a scoping study

“…Retention measures are also limited as they are generally calculated retrospectively: data sources poorly distinguish between the loss to follow‐up and death [ 158 ] and often miss “silent transfers” between different facilities [ 158 ]. This can be addressed by following patients to evaluate alternate outcomes and adjust estimates: either through tracing a sample [ 57 ], using weights from the literature [ 27 , 134 ] or using national/combined databases to follow patients who move between facilities [ 3 , 158 ]. However, all these approaches increase the burden of data collection, linkage and analysis, reducing their feasibility in practice.…”