Adherence and retention on antiretroviral therapy in a public‐private partnership program in Nigeria

Abstract

Initiation of HIV-positive patients on antiretroviral therapy (ART) in Nigeria was restricted to secondary and tertiary level hospitals due to weak health systems in primary health centres (PHCs). Shell Petroleum Development Company (SDPC) Nigeria and FHI 360 using a systems strengthening approach, piloted ART enrolment in a PHC in south-eastern Nigeria. This study sought to evaluate patients’ adherence and mortality on ART, and associated risk factors. We reviewed clinic records of adult patients initiating ART between January 2007 and December 2009. Adherence was calculated as the number of days of medication dispensed as a percentage of total number of days evaluated. Outcome measures were probability of being alive and retained in care at 12 and 24 months on ART. Competing risks regression models were used to assess potential predictors associated with mortality. Total of 196 patients (64.8% males) were initiated on ART. Patients’ median age was 35 years (IQR 30–44); median CD4 at initiation was 132 cells/mm3 (IQR 82–212), Patients in WHO stage III and IV constituted 73 (37.6%) and 83 (42.8%) respectively. Majority (108 [55.1%]) of patients had adherence rates >95%. Adherence levels ranged: 70–85%, 50–65% and <50% in 29 (14.8%), 30 (15.3%) and 29 (14.8%) of patients respectively. Nucleoside backbone use were AZT/3TC (69.4%) d4T/3TC (28.6%) and TDF/FTC (2%). At 12 months of follow up, 80.6% (158) were alive and on ART, mortality accounted for 12.8% (25), 11 (5.6%) were LTFU and 2 (1.1%) transferred out. At 24 months on ART survival decreased to 64.3% (126), 20.4% (40) died, 9.2% (18) were LTFU and 12 (6.1%) transferred out. Competing risks regression models revealed that patients’ factors significantly associated with mortality include: bedridden patients (HR=3.6 [95% CI: 1.11–11.45], p=0.03, referent: working), <50% adherence levels (HR=27.7 [95% CI: 8.55–89.47], p<0.0001, referent: >95% adherence level). In conclusion, majority of attrition was due to mortality. Poor adherence was associated with 27 times higher risk of death compared with patients with >95% adherence. Mortality is likely to reduce by establishing a more robust adherence counselling process.

Quality of live of HIV / AIDS Patients for Loss to Follow Up Antiretroviral Therapy in Semarang, Indonesia

“…Antiretroviral Therapy (ARV) require HIV/AIDS sufferers to be more consistent in taking medication for life, so it takes a high commitment from PLWHA to survive longer. (7)(8)(9)(10)(11)22) The results of this study indicate the reasons for LTFU patients related antiretroviral therapy are influenced by multy factors, this is also supported by their predisposing factors . (23) This was shown by patients whose LTFU turned out to have a CD4 cell count> 350 cells / mm 3 more than retention patients, so they felt healthy and finally did not want any more ARV therapy.…”

“…(3,(6)(7)(8) Antiretroviral treatment (ARV) requires HIV/AIDS patients to be more consistent in taking medication for a lifetime, so it takes a high commitment from PLWHA to survive longer. (9)(10)(11) This has led to an increase in the discovery of cases of Loss to follow-up (LTFU), based on the HIV and AIDS Information System of the Indonesian Ministry of Health until September 2017 it was found data of LTFU 43,707 ( 22%), for Central Java from 2005 to August 2018 data Loss to Follow up: 3.227 people (23%). (3) Research in Zambia and Switzerland on observations of three and a half years of therapy showed an LTFU percentage of 29.3% in patients starting ART with a CD4 count <100 cells/ml and 15.4% for patients starting with ≥ 350 cells/ mL .…”

Scaled-Up Mobile Phone Intervention for HIV Care and Treatment: Protocol for a Facility Randomized Controlled Trial

“…Study health outcomes are ART adherence [ 23 , 30 , 31 ], viral load, retention in care [ 32 , 33 ], and condom use ( Table 1 ). Routine data collection for clinical care related to ART adherence and health outcomes and tracking already occurs in the public sector NACP/GHS health facilities.…”