Implications of adopting new WHO guidelines for antiretroviral therapy initiation in Ethiopia

Konings, E; Ambaw, Yirga; Dilley, Katherine; Gichangi, Peter; Arega, Tesfaye; Crandall, Bud

doi:10.2471/blt.11.089599

Cited by 11 publications

(11 citation statements)

References 4 publications

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“…Data were extracted both from the electronic database and standard registries using a checklist developed from the WHO and Ethiopian national treatment guidelines for pre-ART care [ 13 , 23 ].…”

Section: Methodsmentioning

confidence: 99%

When are patients lost to follow-up in pre-antiretroviral therapy care? a retrospective assessment of patients in an Ethiopian rural hospital

Shaweno

2015

Infect Dis Poverty

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BackgroundThere is concern about the increasing rates of loss to follow-up (LTFU) among pre-antiretroviral therapy (pre-ART) patients in Ethiopia. Little information is available regarding the time when pre-ART patients are lost to follow-up in the country. This study assessed the time when LTFU occurs as well as the associated factors among adults enrolled in pre-ART care in an Ethiopian rural hospital.MethodsData of all adult pre-ART patients enrolled at the Sheka Zonal Hospital between 2010 and 2013 were reviewed. Patients were considered lost to follow-up if they failed to keep scheduled appointments for more than 90 days. The Cox proportional hazards regression model was used to assess factors associated with time until LTFU. The Kaplan-Meier survival table was used to compare the LTFU experiences of patients, segregated by significant predictors.ResultsA total of 626 pre-ART patients were followed for 319.92 person-years of observation (PYOs) from enrolment to pre-ART outcomes, with an overall LTFU rate of 55.8 per 100 PYOs. A total of 178 (28.4%) pre-ART patients were lost to follow-up, 93% of which occurred within the first six months. The median follow-up time was 6.13 months. The independent predictors included: not having been started on co-trimoxazole prophylaxis (adjusted hazard ratio [AHR] = 1.77, 95% confidence interval [CI], 1.12–2.79), a baseline CD4 count of or above 350 cells/mm3 (AHR = 1.87, 95%CI, 1.02–3.45), and an undisclosed HIV status (AHR = 3.04, 95%CI, 2.07–4.45).ConclusionA significant proportion of pre-ART patients is lost to follow-up. Not having been started on co-trimoxazole prophylaxis, presenting to care with a baseline CD4 cell count ≥350 cells/mm3, and an undisclosed HIV status were significant predictors of LTFU among pre-ART patients. Thus, close monitoring and tracking of patients during this period is highly recommended. Those patients with identified risk factors deserve special attention.Electronic supplementary materialThe online version of this article (doi:10.1186/s40249-015-0056-y) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

When are patients lost to follow-up in pre-antiretroviral therapy care? a retrospective assessment of patients in an Ethiopian rural hospital

Shaweno

2015

Infect Dis Poverty

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“…11 In Ethiopia, about 1.2 million people were estimated to be living with HIV in 2011, 12 among whom 62% had access to ART. 13 …”

Section: Introductionmentioning

confidence: 99%

Diabetes mellitus and risk factors in human immunodeficiency virus-infected individuals at Jimma University Specialized Hospital, Southwest Ethiopia

Mohammed¹,

Shenkute²,

Gebisa³

2015

DMSO

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BackgroundGlobally, diabetes is rising dramatically causing high health burden in low- and middle-income countries. It is estimated that about 382 million people had diabetes in 2013. In 2013, diabetes caused 5.1 million deaths globally. Almost 80% of diabetes deaths occur in low- and middle-income countries.PurposeTo assess the magnitude of diabetes mellitus (DM) and associated risk factors in human immunodeficiency virus (HIV)-infected individuals.MethodsAn institution-based cross-sectional study was conducted from April to May 2014 at Jimma University Specialized Hospital. Convenient sampling technique was implemented. Sociodemographic and anthropometric data were collected by senior clinical nurses. Venous blood was collected from each study participant. Serum glucose and lipid profile of the study participants was measured using HumaStar 80 spectrophotometer. Data were analyzed using SPSS version 20. Bivariate and multivariate logistic regressions were utilized.ResultsA total of 393 HIV-infected individuals of age ranging from 21 years to 75 years had enrolled in this study. The overall prevalence of DM in this study was 6.4% (n=25). Two hundred and ninety-one (74%) and 77 (19.6%) of the study participants had normal (70–110 mg/dL) and impaired (111–125 mg/dL) fasting blood glucose values, respectively. After adjusting for the other variables, age (adjusted odds ratio [AOR] =4.812, 95% confidence interval [CI]: 1.668–13.881, P=0.004), duration of highly active antiretroviral therapy (HAART) (AOR =26.928, 95% CI: 3.722–194.822, P=0.001), hypertension (AOR =4.779, 95% CI: 1.646–13.874, P=0.004), and low-density lipoprotein cholesterol (AOR =5.669, 95% CI: 1.849–17.382, P=0.004) were significantly associated with DM.ConclusionHAART may have an impact on the cause of diabetes. Hence, HIV-infected individuals should be screened for diabetes, both before and after initiation of HAART.

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“…For less clear reasons, the plateauing of donor funding for public HIV programmes in sub-Saharan Africa has been associated with delays in ART initiation [15]. Recent World Health Organization (WHO) guidelines expanding recommendations for initiating ART at higher CD4 cell counts have resulted in increasing demand for treatment in HIV programmes, yet a large number of eligible patients are still awaiting initiation [16]. Therefore, as HIV programmes in sub-Saharan Africa expand rapidly, monitoring of timely ART initiation might become an important indicator of the quality of care in ART programmes.…”

Section: Introductionmentioning

confidence: 99%

The clock is ticking: the rate and timeliness of antiretroviral therapy initiation from the time of treatment eligibility in Kenya

Odeny

DeCenso

Gasasira

et al. 2015

Journal of the International AIDS Society

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IntroductionUnderstanding the determinants of timely antiretroviral therapy (ART) initiation is useful for HIV programmes intent on developing models of care that reduce delays in treatment initiation while maintaining a high quality of care. We analysed patient- and facility-level determinants of time to ART initiation among patients who initiated ART in Kenya.MethodsWe collected facility-level information and conducted a retrospective chart review of adults initiating ART between 2007 and 2012 at 51 health facilities in Kenya. We evaluated the association between patient- and facility-level covariates at the time of ART eligibility and time to ART initiation. We also explored the determinants associated with timeliness of ART initiation.ResultsThe analysis included 11,942 patients. The median age at the time eligibility was first determined was 37 years (interquartile range [IQR] 31–45). Overall, 75% of patients initiated ART within two months of eligibility. The median CD4 cell count at the time eligibility was first determined rose from 132 (IQR 51–217) in 2007 to 195 (IQR 91–286) in 2011 to 2012 (p<0.001). The cumulative probability of ART initiation among treatment-eligible patients increased over time: 87.1% (95% confidence interval [CI] 85.1–89.0%) in 2007; 96.8% (96.0–97.5%) in 2008; 97.1% (96.3–97.7%) in 2009; 98.5% (98.0 −98.9%) in 2010; and 99.7% (95% CI 99.4 −99.8%) in 2011 to 2012 (p<0.0001). In multivariate analyses, attending a health facility with high ART patient volumes within two months of eligibility was considered the key facility-level determinant of ART initiation (adjusted odds ratio 0.57, 95% CI 0.45–0.72, p<0.001). Patient-level determinants included being eligible for ART in the years subsequent to 2007, advanced World Health Organization clinical stage and low CD4 cell count at the time eligibility was first determined.ConclusionsOverall, the time between treatment eligibility and ART initiation decreased substantially in Kenya between 2007 and 2012, with uniform gains across different types of health facilities. Our findings highlight the slow increase in CD4 cell counts at the time of ART eligibility over time, indicating that a large number of patients are still beginning ART with advanced HIV disease. Our findings also support the decentralisation of ART services at all health facilities that have the capacity to initiate treatment. Continued evaluation of programme- and country-level data is needed to monitor timeliness of ART initiation as countries continue to expand treatment access.

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Implications of adopting new WHO guidelines for antiretroviral therapy initiation in Ethiopia

Cited by 11 publications

References 4 publications

When are patients lost to follow-up in pre-antiretroviral therapy care? a retrospective assessment of patients in an Ethiopian rural hospital

When are patients lost to follow-up in pre-antiretroviral therapy care? a retrospective assessment of patients in an Ethiopian rural hospital

Diabetes mellitus and risk factors in human immunodeficiency virus-infected individuals at Jimma University Specialized Hospital, Southwest Ethiopia

The clock is ticking: the rate and timeliness of antiretroviral therapy initiation from the time of treatment eligibility in Kenya

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