Long-Term Antiretroviral Treatment Outcomes in Seven Countries in the Caribbean

Koenig, Serena P.; Rodríguez, Luis A.; Bartholomew, Courtenay; Edwards, Alison; Carmichael, Tracie E.; Barrow, G; Cabie, André; Hunter, R. F.; Vasquez-Mora, Giselle; Quava-Jones, Avion; Adomakoh, Nicholas; Figueroa, J. Peter; Liautaud, Bernard; Torres, Magaly; Pape, Jean William

doi:10.1097/qai.0b013e318245d3c1

Cited by 32 publications

(32 citation statements)

References 45 publications

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“…Our rates of LTF are higher than the rate of 16.1 persons/100 PY who were lost in the first six months of treatment reported among patients who initiated ART between 1999 and 2008 in the GHESKIO HIV specialty clinic in Port-au-Prince [9]. Our results of an increasing trend in LTF over time are similar to LTF trends reported from other HIV programs in developing countries [7, 33–36].…”

Section: Discussionsupporting

confidence: 81%

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Outcomes after antiretroviral therapy during the expansion of HIV services in Haiti

et al. 2017

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BackgroundWe report patient outcomes after antiretroviral therapy (ART) initiation in a network of HIV facilities in Haiti, including temporal trends and differences across clinics, during the expansion of HIV services in the country.MethodsWe assessed outcomes at 12 months after ART initiation (baseline) using routinely collected data on adults (≥15 years) in 11 HIV facilities from July 2007-December 2013. Outcomes include death (ascertained from medical records), lost to follow-up (LTF) defined as no visit > 365 days from ART initiation, and retention defined as being alive and attending care ≥ 365 days from ART initiation. Outcomes were compared across calendar year of ART initiation and across facilities. Risk factors for death and LTF were assessed using Cox proportional hazards and competing risk regression models.ResultsCumulatively, 9,718 adults initiated ART with median age 37 years (IQR 30–46). Median CD4 count was 254 cells/uL (IQR 139–350). Twelve months after ART initiation, 4.4% (95% CI 4.0–4.8) of patients died, 21.7% (95% CI 20.9–22.6) were LTF, and 73.9% (95% CI 73.0–74.8) were retained in care. Twelve-month mortality decreased from 13.8% among adults who started ART in 2007 to 4.4% in 2013 (p<0.001). Twelve-month LTF after ART start was 29.2% in 2007, 18.7% in 2008, and increased to 30.1% in 2013 (p<0.001). Overall, twelve-month retention after ART start did not change over time but varied widely across facilities from 61.1% to 86.5%.ConclusionExpansion of HIV services across Haiti has been successful with increasing numbers of patients initiating ART and decreasing twelve-month mortality rates. However, overall retention has not improved, despite differences across facilities, suggesting additional strategies to improve engagement in care are needed.

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Section: Discussionsupporting

confidence: 81%

“…The marked heterogeneity in outcomes across facilities has been reported in other multi-country cohort studies [8, 9, 11, 36]. Differences could in part be explained by differences in undocumented deaths among patients categorized as lost.…”

Section: Discussionmentioning

confidence: 82%

Outcomes after antiretroviral therapy during the expansion of HIV services in Haiti

et al. 2017

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“…Lower pre-ART duration has been identified as a risk factor for ART attrition in Haiti [30]. The higher risk of ART failure we found among males is consistent with evidence of elevated ART attrition risk among males in Haiti and elsewhere in the Caribbean region [31].…”

Section: Discussionsupporting

confidence: 87%

Development of an Electronic Medical Record Based Alert for Risk of HIV Treatment Failure in a Low-Resource Setting

Puttkammer

Zeliadt

Balan³

et al. 2014

PLoS ONE

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BackgroundThe adoption of electronic medical record systems in resource-limited settings can help clinicians monitor patients' adherence to HIV antiretroviral therapy (ART) and identify patients at risk of future ART failure, allowing resources to be targeted to those most at risk.MethodsAmong adult patients enrolled on ART from 2005–2013 at two large, public-sector hospitals in Haiti, ART failure was assessed after 6–12 months on treatment, based on the World Health Organization's immunologic and clinical criteria. We identified models for predicting ART failure based on ART adherence measures and other patient characteristics. We assessed performance of candidate models using area under the receiver operating curve, and validated results using a randomly-split data sample. The selected prediction model was used to generate a risk score, and its ability to differentiate ART failure risk over a 42-month follow-up period was tested using stratified Kaplan Meier survival curves.ResultsAmong 923 patients with CD4 results available during the period 6–12 months after ART initiation, 196 (21.2%) met ART failure criteria. The pharmacy-based proportion of days covered (PDC) measure performed best among five possible ART adherence measures at predicting ART failure. Average PDC during the first 6 months on ART was 79.0% among cases of ART failure and 88.6% among cases of non-failure (p<0.01). When additional information including sex, baseline CD4, and duration of enrollment in HIV care prior to ART initiation were added to PDC, the risk score differentiated between those who did and did not meet failure criteria over 42 months following ART initiation.ConclusionsPharmacy data are most useful for new ART adherence alerts within iSanté. Such alerts offer potential to help clinicians identify patients at high risk of ART failure so that they can be targeted with adherence support interventions, before ART failure occurs.

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“…It did not include the cost of hospitalization, though this was a minor cost in other GHESKIO studies [10, 31]. Although previous literature suggests that baseline demographics and treatment characteristics may impact both cost and outcomes, the adjusted results confirm the findings of the unadjusted analysis and indicate that differences in costs between the two cohorts remain irrespective of observed differences in ART regimen, education and weight at baseline [4, 10, 41, 42]. …”

Section: Discussionmentioning

confidence: 78%

Superior Outcomes and Lower Outpatient Costs With Scale-Up of Antiretroviral Therapy at the GHESKIO Clinic in Port-au-Prince, Haiti

Riviere

Faust

Miller

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Treatment protocols and prices of antiretroviral therapy (ART) have changed over time. Yet limited data exist to evaluate the impact of these changes on patient outcomes and treatment costs in resource-poor settings. Methods We compared patient-level data on outcomes, utilization, and cost for the first two years of ART for a cohort of adult patients initiating ART in 2003–2004 and a cohort initiating ART in 2006–2008 at the GHESKIO clinic in Port-au-Prince, Haiti. Costs were measured from the health center perspective. Multivariate analyses were conducted to account for the potential impact of differences in disease severity at baseline. Results With the exclusion of patients who transferred care, 92% (167/181) of patients in the 2006–2008 cohort and 75% (150/200) in the 2003–2004 cohort were alive and in-care at the end of the study period. The mean cost per patient for the two-year study period was US$723 for the 2006–2008 cohort vs. US$1,191 for the 2003–2004 cohort, a cost difference of US$468 (p<0.0001). The mean cost per patient alive and in-care at the end of the two-year study period was US$744 for the 2006–2008 cohort vs. US$1,489 for the 2003–2004 cohort (p<0.0001). Conclusions HIV treatment outcomes in Haiti have improved over time while treatment costs declined by over 50% per patient alive and in-care at the end of the two-year study period. The major drivers in the reduction of treatment costs were the lower price of ART, lower costs for laboratory testing, and lower overhead costs.

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Long-Term Antiretroviral Treatment Outcomes in Seven Countries in the Caribbean

Cited by 32 publications

References 45 publications

Outcomes after antiretroviral therapy during the expansion of HIV services in Haiti

Outcomes after antiretroviral therapy during the expansion of HIV services in Haiti

Development of an Electronic Medical Record Based Alert for Risk of HIV Treatment Failure in a Low-Resource Setting

Superior Outcomes and Lower Outpatient Costs With Scale-Up of Antiretroviral Therapy at the GHESKIO Clinic in Port-au-Prince, Haiti

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