Trends, treatment outcomes, and determinants for attrition among adult patients in care at a large tertiary HIV clinic in Nairobi, Kenya: a 2004&amp;ndash;2015 retrospective cohort study

Mecha, Jerphason; Kubo, Elizabeth N.; Ng’ang’a, Lucy; Muiruri, Peter; Njagi, Lilian N.; Ilovi, S.; Ngethe, Richard; Mutisya, Immaculate; Ngugi, Evelyn; Maleche‐Obimbo, Elizabeth

doi:10.2147/hiv.s153185

Cited by 9 publications

(5 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Known predictors of attrition include low initial CD4 T-cell lymphocyte counts, low baseline body mass index (BMI), history of hospitalization, advanced WHO clinical staging, older age at HIV diagnosis, and being a man 11 – 13 . Other studies from the region show anemia and decreased red blood cell counts and platelets as predictors of death during the first year of ART treatment 14 .…”

Section: Introductionmentioning

confidence: 99%

Predictors of attrition among adults in a rural HIV clinic in southern Mozambique: 18-year retrospective study

Nacarapa¹,

Verdu²,

Nacarapa³

et al. 2021

Sci Rep

View full text Add to dashboard Cite

HIV remains a major cause of morbidity and mortality for people living in many low-income countries. With an HIV prevalence of 12.4% among people aged over 15 years, Mozambique was ranked in 2019 as one of eight countries with the highest HIV rates in the world. We analyzed routinely collected data from electronical medical records in HIV-infected patients aged 15 years or older and enrolled at Carmelo Hospital of Chokwe in Chokwe from 2002 to 2019. Attrition was defined as individuals who were either reported dead or lost to follow-up (LTFU) (≥ 90 days since the last clinic visit with missed medical pick-up after 3 days of failed calls). Kaplan–Meier survival curves and Cox regression analyses were used to model the incidence and predictors of time to attrition. From January 2002 to December 2019, 16,321 patients were enrolled on antiretroviral therapy (ART): 59.2% were women, and 37.9% were aged 25–34 years old. At the time of the analysis, 7279 (44.6%) were active and on ART. Overall, the 16,321 adults on ART contributed a total of 72,987 person-years of observation. The overall attrition rate was 9.46 per 100 person-years. Cox regression showed a higher risk of attrition in those following an inpatient regimen (hazard ratio [HR] 3.18, 95% confidence interval [CI] 2.89–3.50; p < 0.001), having CD4 counts under 50 cells/µL (HR 1.91, 95% CI 1.63–2.24, p < 0.001), receiving anti-TB treatment within 90 days of ART initiation (HR 6.53, 95% CI 5.72–7.45; p < 0.001), classified as WHO clinical stage III (HR 3.75, 95% CI 3.21–4.37; p < 0.001), and having Kaposi’s sarcoma (HR 1.99, 95% CI 1.65–2.39, p < 0.001). Kaplan–Meier analysis showed that patients with CD4 counts of less than 50 cells/µL on ART initiation had a 40% lower chance of survival at 18 years. Low CD4 cell counts, ART initiation as an inpatient, WHO clinical stage III, and anti-tuberculosis treatment within 90 days of ART initiation were strongly associated with attrition. Strengthening HIV testing and ART treatment, improving the diagnosis of tuberculosis before ART initiation, and guaranteed psychosocial support systems are the best tools to reduce patient attrition after starting ART.

show abstract

Section: Introductionmentioning

confidence: 99%

Predictors of attrition among adults in a rural HIV clinic in southern Mozambique: 18-year retrospective study

Nacarapa¹,

Verdu²,

Nacarapa³

et al. 2021

Sci Rep

View full text Add to dashboard Cite

show abstract

“…However, finding was also higher when compared to studies done in Zimbabwe (AHR = 0.74), Kenya (AHR = 0.232), and Adama (AHR = 0.42),. 5 , 12 , 22 , 23 Patients with advanced WHO clinical stages III or IV also underwent more attrition from the treatment as compared to those in stage I. Early HIV diagnosis and initiation of treatment could increase survival rates; this might be due to the “Test and Treat” approach.…”

Section: Discussionmentioning

confidence: 99%

Incidence and predictors of attrition among adults receiving first line anti-retroviral therapy at public health facility in Adea Berga district, Oromia, Ethiopia

Kassa,

Dingeta,

Gobana

et al. 2023

Journal of Public Health Research

View full text Add to dashboard Cite

Background: According to current estimates, there are 665,723 people in Ethiopia who have human immunodeficiency syndrome. As Ethiopia inches closer to attaining the 95/95/95 targets for treatment coverage and reaching epidemic control, however, attrition from anti-retroviral treatment is still one of the key programmatic challenges. Objective: To assess the incidence of attrition rate and its predictors among adult HIV patients receiving anti retro viral treatment at Public Health Facility in Adea Berga/Enchini District. Method: A 6-year (June 28, 2015 to June 27, 2021) institution-based retrospective cohort study was used to recruit 540 study participants by using simple random sampling. Data were obtained from chart review, coded, entered into Epi Data, and exported to Stata 14.2 software for analysis. At least 1 month missed appointment is considered as attrition and the predictors of attrition were identified using bivariable and multivariable Cox proportional hazard models and an adjusted hazard ratio (AHR). Bivariate and multivariate analyses were conducted to find predictors of attrition, p-value < 0.05 was considered statistically significant. Results: From the total 540 study participant, 158 (29.26%) patients were discontinuing from follow up making the incidence rate of attrition 9.50 per 100 person years .Being WHO clinical stage III or IV (AHR = 1.96,), non-practice of Appointment spacing model (AHR = 3.98), poor or fair ART adherence level (AHR = 6.47), age groups (15–24) years (AHR = 1.73) and Others ART linkage points[index case testing, tuberculosis clinic and referral from private/public health institutions] (AHR = 1.76) were significantly associated. Conclusions: The study showed that the incidence of attrition among adults receiving antiretroviral therapy was high. Patient sociodemographic, clinical, and treatment-related factors were significantly associated with patients on ART.

show abstract

“…Most of these previous studies have not reported TB treatment outcomes disaggregated by HIV status. It is likely the TB/HIV prevalence could also have changed over time because of the vast investment in controlling and preventing HIV or the increased access to ART by PLHIV [ 15 , 16 ]. Over the years, policy of HIV testing in Kenya has changed from self-initiated voluntary counselling & testing (VCT) to provider-initiated testing & counselling (PITC) [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Burden of HIV and treatment outcomes among TB patients in rural Kenya: a 9-year longitudinal study

et al. 2023

View full text Add to dashboard Cite

Background Although tuberculosis (TB) patients coinfected with HIV are at risk of poor treatment outcomes, there is paucity of data on changing trends of TB/HIV co-infection and their treatment outcomes. This study aims to estimate the burden of TB/HIV co-infection over time, describe the treatment available to TB/HIV patients and estimate the effect of TB/HIV co-infection on TB treatment outcomes. Methods This was a retrospective data analyses from TB surveillance in two counties in Kenya (Nyeri and Kilifi): 2012‒2020. All TB patients aged ≥ 18 years were included. The main exposure was HIV status categorised as infected, negative or unknown status. World Health Organization TB treatment outcomes were explored; cured, treatment complete, failed treatment, defaulted/lost-to-follow-up, died and transferred out. Time at risk was from date of starting TB treatment to six months later/date of the event and Cox proportion with shared frailties models were used to estimate effects of TB/HIV co-infection on TB treatment outcomes. Results The study includes 27,285 patients, median (IQR) 37 (29‒49) years old and 64% male. 23,986 (88%) were new TB cases and 91% were started on 2RHZE/4RH anti-TB regimen. Overall, 7879 (29%, 95% 28‒30%) were HIV infected. The proportion of HIV infected patient was 32% in 2012 and declined to 24% in 2020 (trend P-value = 0.01). Uptake of ARTs (95%) and cotrimoxazole prophylaxis (99%) was high. Overall, 84% patients completed six months TB treatment, 2084 (7.6%) died, 4.3% LTFU, 0.9% treatment failure and 2.8% transferred out. HIV status was associated with lower odds of completing TB treatment: infected Vs negative (aOR 0.56 (95%CI 0.52‒0.61) and unknown vs negative (aOR 0.57 (95%CI 0.44‒0.73). Both HIV infected and unknown status were associated with higher hazard of death: (aHR 2.40 (95%CI 2.18‒2.63) and 1.93 (95%CI 1.44‒2.56)) respectively and defaulting treatment/LTFU: aHR 1.16 (95%CI 1.01‒1.32) and 1.55 (95%CI 1.02‒2.35)) respectively. HIV status had no effect on hazard of transferring out and treatment failure. Conclusion The overall burden of TB/HIV coinfection was within previous pooled estimate. Our findings support the need for systematic HIV testing as those with unknown status had similar TB treatment outcomes as the HIV infected.

show abstract

Trends, treatment outcomes, and determinants for attrition among adult patients in care at a large tertiary HIV clinic in Nairobi, Kenya: a 2004–2015 retrospective cohort study

Cited by 9 publications

References 24 publications

Predictors of attrition among adults in a rural HIV clinic in southern Mozambique: 18-year retrospective study

Predictors of attrition among adults in a rural HIV clinic in southern Mozambique: 18-year retrospective study

Incidence and predictors of attrition among adults receiving first line anti-retroviral therapy at public health facility in Adea Berga district, Oromia, Ethiopia

Burden of HIV and treatment outcomes among TB patients in rural Kenya: a 9-year longitudinal study

Contact Info

Product

Resources

About