Failure to return pillbox is a predictor of being lost to follow‐up among people living with HIV on antiretroviral therapy in rural Tanzania

Fue, Gideon; Shabani, Siraji; Weisser, Maja; Bani, Farida; Battegay, Manuel; Byakuzana, Theonestina; Chale, Adolphina; Chuwa, Francisca; Eichenberger, Anna; Francis, Gideon; Furrer, Hansjakob; Glass, Tracy R.; Hwaya, Speciosa; Kalinjuma, Aneth Vedastus; Kasuga, Bryson; Katende, Andrew; Kimera, Namvua; Kivuma, Bernard; Kisunga, Yassin; Kitau, Olivia; Klimkait, Thomas; Luoga, Ezekiel; Mapesi, Herry; Mkulila, Mengi; Mkumbo, Julius; Mkusa, Margareth; Mlembe, Slyakus; Mnzava, Dorcas; Mollel, Gertrud J.; Moshi, Lilian; Mossad, Germana; Mpundunga, Dolores; Mtandanguo, Athumani; Myeya, Selerine; Nahota, Sanula; Ndaki, Regina; Ndege, Robert; Ngulukila, Agatha; Nyuri, Amina; Okuma, James; Paris, Daniel; Sambuta, Aloyce; Samson, Leila; Senkoro, Elizabeth; Sikalengo, George; Tarimo, Jenifa; Temba, Yvan; Utzinger, Jüerg; Vanobberghen, Fiona; Wigay, John; Wilson, Herieth

doi:10.1111/hiv.13223

Cited by 5 publications

(2 citation statements)

References 43 publications

(48 reference statements)

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“…We did not ascertain treatment failure as an outcome of LTFU from ART care using CD4 counts and viral load counts. However, a strong link between LTFU and treatment failure published in various studies in Tanzania and elsewhere provide justification for addressing LTFU among adolescents [ 25 , 47 ]. Also, we were not able to assess if adolescents presented for care at other clinics during the two-year follow-up time.…”

Section: Discussionmentioning

confidence: 99%

Predictors of loss to follow up from antiretroviral therapy among adolescents with HIV/AIDS in Tanzania

Tesha

Kishimba²,

Njau³

et al. 2022

PLoS ONE

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Access to Antiretroviral Therapy (ART) is threatened by the increased rate of loss to follow-up (LTFU) among adolescents on ART care. We investigated the rate of LTFU from HIV care and associated predictors among adolescents living with HIV/AIDS in Tanzania. A retrospective cohort analysis of adolescents on ART from January 2014 to December 2016 was performed. Kaplan-Meier method was used to determine failure probabilities and the Cox proportion hazard regression model was used to determine predictors of loss to follow up. A total of 25,484 adolescents were on ART between 2014 and 2016, of whom 78.4% were female and 42% of adolescents were lost to follow-up. Predictors associated with LTFU included; adolescents aged 15–19 years (adjusted hazard ratio (aHR): 1.57; 95% Confidence Interval (CI); 1.47–1.69), having HIV/TB co-infection (aHR: 1.58; 95% CI, 1.32–1.89), attending care at dispensaries (aHR: 1.12; 95% CI, 1.07–1.18) or health center (aHR: 1.10; 95% CI, 1.04–1.15), and being malnourished (aHR: 2.27; 95% CI,1.56–3.23). Moreover, residing in the Lake Zone and having advanced HIV disease were associated with LTFU. These findings highlight the high rate of LTFU and the need for intervention targeting older adolescents with advanced diseases and strengthening primary public facilities to achieve the 2030 goal of ending HIV as a public health threat.

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Section: Discussionmentioning

confidence: 99%

Predictors of loss to follow up from antiretroviral therapy among adolescents with HIV/AIDS in Tanzania

Tesha

Kishimba²,

Njau³

et al. 2022

PLoS ONE

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“…9 In 2019, a study in Tanzania found LTFU among PLHIV to be 35.6% at 33 months since the initiation of ART care. 10 Men are more likely to be lost and less likely to be retained in care and achieve virological suppression than women. [11][12][13][14][15] This likelihood may be partly influenced by social norms which make them unable to express their feelings towards their health needs.…”

Section: Introductionmentioning

confidence: 99%

Factors Contributing to Loss to Follow-Up from HIV Care Among Men Living with HIV/AIDS in Kibaha District, Tanzania

Mandawa¹,

Mahiti²

2022

HIV

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Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) remains a global public health challenge and epidemic disease in sub-Saharan African (SSA) countries. Retention in HIV care should be emphasized to reach", 95-95-95" the Joint United Nations Program on HIV/AIDS (UNAIDS) target by 2030. In Tanzania, in spite of existing strategies to ensure retention, loss to follow-up (LTFU) among HIV-infected men is still a common challenge. With limited studies focusing on men's population, little is known on their perspectives on factors contributing to LTFU. This study aimed to explore factors contributing to LTFU among men living with HIV/AIDS in the Kibaha district and to try to formulate strategies that work for men. Methods: The qualitative study using a phenomenological approach was conducted among 16 men with experience in LTFU from three HIV care and treatment clinics located in the Kibaha district. Purposive sampling was used to select informants for semistructured in-depth interviews from August to December, 2021. The collected data was analyzed thematically. Results: The findings were grouped into three themes which highlightedthe contribution of individual factors, socio-economic factors and health system factors. These factors include anticipated HIV-related stigma, lack of disclosure of their HIV status to their partners, poor knowledge on HIV care, unbearable antiretroviral (ART) medication side effects, sharing of ART medications with their partners, perceived good health status, financial difficulties, work-related travels, demanding employment schedules, spiritual belief in faith healing, poor conduct among healthcare workers and loss of Care and Treatment Clinic (CTC) cards hindered their use of ART services at clinics. Conclusion:The findings from this study revealed linked multi-level factors that influence LTFU from HIV care among HIV-infected men. In order to retain men in HIV care, tailored intervention approaches should be formulated.

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Point-of-Care Tenofovir Urine Testing for the Prediction of Treatment Failure and Drug Resistance During Initial Treatment for Human Immunodeficiency Virus Type 1 (HIV-1) Infection

Hermans

Umunnakwe²,

Lalla-Edward

et al. 2022

Clinical Infectious Diseases

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Background Viral rebound during antiretroviral treatment (ART) is most often driven by suboptimal adherence in the absence of drug resistance. We assessed the diagnostic performance of point-of-care (POC) tenofovir (TFV) detection in urine for the prediction of viral rebound and drug resistance during ART. Methods We performed a nested case-control study within the ADVANCE randomized clinical trial (NCT03122262) in Johannesburg, South Africa. Adult outpatients living with HIV and newly initiating ART were randomized to receive either dolutegravir or efavirenz, tenofovir disoproxil fumarate or alafenamide, and emtricitabine. All participants with rebound ≥200 copies/mL between 24 and 96 weeks of follow-up were selected as cases and matched to controls with virological suppression <50 copies/mL. Rapid POC urine-TFV detection was performed retrospectively. Results We included 281 samples from 198 participants. Urine-TFV was detectable in 30.7% (70/228) of cases and in 100% (53/53) of controls. Undetectable urine-TFV predicted rebound with a sensitivity of 69% [95%CI 63-75] and specificity of 100% [93-100]. In cases with virological failure and sequencing data (n = 42), NRTI drug resistance was detected in 50% (10/20) of cases with detectable urine-TFV versus in 8.3% (2/24) of cases with undetectable urine-TFV. Detectable urine-TFV predicted NRTI resistance (OR 10.4 [1.8-114.4] p = 0.005) with a sensitivity of 83% [52-98] and specificity of 69% [50-84]. Conclusions Point-of-care objective adherence testing using a urine-TFV test predicted viral rebound with high specificity. In participants with rebound, urine-TFV testing predicted the selection of drug resistance. Objective adherence testing may be used to rapidly provide insight into adherence, suppression, and drug resistance during ART.

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Failure to return pillbox is a predictor of being lost to follow‐up among people living with HIV on antiretroviral therapy in rural Tanzania

Cited by 5 publications

References 43 publications

Predictors of loss to follow up from antiretroviral therapy among adolescents with HIV/AIDS in Tanzania

Predictors of loss to follow up from antiretroviral therapy among adolescents with HIV/AIDS in Tanzania

Factors Contributing to Loss to Follow-Up from HIV Care Among Men Living with HIV/AIDS in Kibaha District, Tanzania

Point-of-Care Tenofovir Urine Testing for the Prediction of Treatment Failure and Drug Resistance During Initial Treatment for Human Immunodeficiency Virus Type 1 (HIV-1) Infection

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