Predictors of loss to follow-up in patients living with HIV/AIDS after initiation of antiretroviral therapy

Berheto, Tezera Moshago; Haile, Demissew Berihun; Mohammed, Salahuddin

doi:10.4103/1947-2714.141636

Cited by 84 publications

(86 citation statements)

References 32 publications

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“…Without the availability of, and access to, these basic tests, monitoring for ART toxicity cannot be performed, and could compromise the long-term effectiveness and sustainability of the ART program. Researches have showed that HIV patients on ART who have regimen substitution due to drug toxicity/drug related adverse reactions were at higher risk of loss to follow-up [44, 45] which may partly explain the significant reduction in number of patients in care after five years of follow-up reported from study included in this review [19]. …”

Section: Discussionmentioning

confidence: 99%

Feasibility of antiretroviral treatment monitoring in the era of decentralized HIV care: a systematic review

et al. 2017

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BackgroundRegular monitoring of HIV patients who are receiving antiretroviral therapy (ART) is required to ensure patient benefits and the long-term effectiveness and sustainability of ART programs. Prompted by WHO recommendations for expansion and decentralization of HIV treatment and care in low and middle income countries, we conducted a systematic review to assess the feasibility of treatment monitoring in these settings.MethodsA comprehensive search strategy was developed using a combination of MeSH and free text terms relevant to HIV treatment and care, health service delivery, health service accessibility, decentralization and other relevant terms. Five electronic databases and two conference websites were searched to identify relevant studies conducted in LMICs, published in English between Jan 2006 and Dec 2015. Outcomes of interest included the proportion of patients who received treatment monitoring and health system factors related to monitoring of patients on ART under decentralized HIV service delivery models.ResultsFrom 5363 records retrieved, twenty studies were included in the review; all but one was conducted in sub-Saharan African countries. The majority of studies (15/20) had relatively short follow-up duration (≤24 months), and only two studies were specifically designed to assess treatment monitoring practices. The most frequently studied follow-up period was 12 months and a wide range of treatment monitoring coverage was observed. The reported proportions of patients on ART who received CD4 monitoring ranged from very low (6%; N = 2145) to very high (95%; N = 488). The median uptake of viral load monitoring was 86% with studies in program settings reporting coverage as low as 14%. Overall, the longer the follow-up period, the lower the proportion of patients who received regular monitoring tests; and programs in rural areas reported low coverage of laboratory monitoring. Moreover, uptake in the context of research had significantly better where monitoring was done by dedicated research staff. In the absence of point of care (POC) testing, the limited capacity for blood sample transportation between clinic and laboratory and poor quality of nursing staff were identified as a major barrier for treatment monitoring practice.ConclusionsThere is a paucity of data on the uptake of treatment monitoring, particularly with longer-term follow-up. Wide variation in access to both virological and immunological regular monitoring was observed, with some clinics in well-resourced settings supported by external donors achieving high coverage. The feasibility of treatment monitoring, particularly in decentralized settings of HIV treatment and care may thus be of concern and requires further study. Significant investment in POC diagnostic technologies and, improving the quality of and training for nursing staff is required to ensure effective scale up of ART programs towards the targets of 90-90-90 by the year 2020.Electronic supplementary materialThe online version of this article (doi:10.1186/s12981-017-0...

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Section: Discussionmentioning

confidence: 99%

Feasibility of antiretroviral treatment monitoring in the era of decentralized HIV care: a systematic review

et al. 2017

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“…Studies conducted in Aksum St Marry Hospital[8], Mizan Aman General Hospital[10], Jimma University Specialized Hospital[23] and University of Gondar[24] reported that the proportion of LTFU was 9.8%, 26.7%, 28% and 31.4%, respectively. Additionally, a retrospective study from Ethiopia reported that retention of patients in care was a major challenge and varied across health facilities[25].…”

Section: Introductionmentioning

confidence: 99%

“…Primary studies conducted in Ethiopia reported socio-demographic, behavioral, clinical and institutional factors as contributors to discontinuation[7–10]. However, different studies showed conflicting association, and the existence of additional factors challenging interventions.…”

Section: Introductionmentioning

confidence: 99%

“…A study from five East African countries revealed the existence of 14 different definitions of ART defaulting were in use[26]. Currently, the definition of LTFU in Ethiopia is also not uniform, and has included a patient discontinuing from ART for more than one[8], two[9], three[10,27–29] or twelve[30] months. Additional studies have considered a ‘defaulter’ when a patient discontinues from ART for more than two months [7,23].…”

Section: Introductionmentioning

confidence: 99%

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Discontinuation from Antiretroviral Therapy: A Continuing Challenge among Adults in HIV Care in Ethiopia: A Systematic Review and Meta-Analysis

et al. 2017

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BackgroundDiscontinuation of antiretroviral therapy (ART) reduces the immunological benefit of treatment and increases complications related to human immune-deficiency virus (HIV). However, the risk factors for ART discontinuation are poorly understood in developing countries particularly in Ethiopia. This review aimed to assess the best available evidence regarding risk factors for ART discontinuation in Ethiopia.MethodsQuantitative studies conducted in Ethiopia between 2002 and 2015 that evaluated factors associated with ART discontinuation were sought across six major databases. Only English language articles were included. This review considered studies that included the following outcome: ART treatment discontinuation, i.e. ‘lost to follow up’, ‘defaulting’ and ‘stopping medication’. Meta- analysis was performed with Mantel Haenszel method using Revman-5 software. Summary statistics were expressed as pooled odds ratio with 95% confidence intervals at a p-value of <0.05.ResultsNine (9) studies met the criteria of the search. Five (5) were retrospective studies, 3 were case control studies, and 1 was a prospective cohort study. The total sample size in the included studies was 62,156. Being rural dweller (OR = 2.1, 95%CI: 1.5–2.7, I2 = 60%), being illiterate (OR = 1.5, 95%CI: 1.1–2.1), being not married (OR = 1.4, 95%CI: 1.1–1.8), being alcohol drinker (OR = 2.9, 95%CI: 1.9–4.4, I2 = 39%), being tobacco smoker (OR = 2.6, 95%CI: 1.6–4.3, I2 = 74%), having mental illness (OR = 2.7, 95%CI: 1.6–4.6, I2 = 0%) and being bed ridden functional status (OR = 2.3, 95%CI: 1.5–3.4, I2 = 37%) were risk factors for ART discontinuation. Whereas, having HIV positive partner (OR = 0.4, 95%CI: 0.3–0.6, I2 = 69%) and being co-infected with Tb/HIV (OR = 0.6, 95%CI: 0.4–0.9, I2 = 0%) were protective factors.ConclusionDemographic, behavioral and clinical factors influenced ART treatment discontinuation. Hence, we recommend strengthening decentralization of HIV care services in remote areas, strengthening of ART task shifting, application of seek-test-treat-succeed model, and integration of smoking cession strategies and mental health care into the routine HIV care program.

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“…In the existing literature, there are reports that have evaluated the association between CD4 + at cART initiation and loss to follow-up (LTFU). However, these results are conflicting [25–28] and are less relevant, as treatment guidelines have evolved substantially regarding cART initiation eligibility [17,29]. Some studies, although few, have looked at other mechanisms that may be related to mortality outcomes by CD4 + at cART initiation [30–36].…”

Section: Introductionmentioning

confidence: 99%

Initiation of antiretroviral therapy at high CD4+ cell counts is associated with positive treatment outcomes

Lima

Reuter

Harrigan

et al. 2015

Aids

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Objective There is limited research investigating the possible mechanisms of how starting combination antiretroviral therapy (cART) at a higher CD4+ cell count decreases mortality. This study investigated the association between initiating cART with short-term and long-term achievement of viral suppression; emergence of any drug resistance and of an AIDS-defining illness (ADI); long-term treatment adherence; and all-cause mortality. Methods This retrospective cohort study included 4120 naive patients who initiated cART between 2000 and 2012. Patients were followed until 2013, death or until the last contact date (varied by outcome). The main exposure was the interaction between period of cART initiation (2000–2006 and 2007–2012) and CD4+ cell count at cART initiation (<500 versus ≥500 cells/μl). We considered both baseline and longitudinal covariates. We fitted different multivariable models using cross-sectional and longitudinal statistical methods, depending on the outcome. Results Patients who initiated cART with a CD4+ cell count at least 500cells/μl in 2007–2012 had an increased likelihood of achieving viral suppression at 9 months and of maintaining an adherence level of at least 95% overtime, and the lowest probability of developing any resistance and an ADI during follow-up. These patients were not the ones with the highest likelihood of maintaining viral suppression over time, most likely due to viral load blips experienced during the follow-up. Conclusion The outcomes in this study likely play an important role in explaining the positive impact of early cART initiation on mortality. These results should alleviate some of the concerns clinicians may have when initiating cART in patients with high CD4+s as recommended by current treatment guidelines.

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Predictors of loss to follow-up in patients living with HIV/AIDS after initiation of antiretroviral therapy

Cited by 84 publications

References 32 publications

Feasibility of antiretroviral treatment monitoring in the era of decentralized HIV care: a systematic review

Feasibility of antiretroviral treatment monitoring in the era of decentralized HIV care: a systematic review

Discontinuation from Antiretroviral Therapy: A Continuing Challenge among Adults in HIV Care in Ethiopia: A Systematic Review and Meta-Analysis

Initiation of antiretroviral therapy at high CD4+ cell counts is associated with positive treatment outcomes

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