Loss of HIV-infected patients on potent antiretroviral therapy programs in Togo: risk factors and the fate of these patients

Saka, Bayaki; Landoh, Dadja Essoya; Patassi, Akouda; d’Almeida, S.; Singo, A.; Gessner, Bradford D.; Pitché, P.

doi:10.11604/pamj.2013.15.35.2198

Cited by 21 publications

(21 citation statements)

References 19 publications

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“… 17 , 21 , 28 – 30 The association between advanced disease conditions at ART initiation (low CD4, AIDS stage) and higher probability of death or being LTFU has been largely observed. 10 , 11 , 15 – 17 , 31 – 36 This seems to be the most important factor associated with LTFU in the oldest group.…”

Section: Discussionmentioning

confidence: 94%

Aging with HIV: what effect on mortality and loss to follow-up in the course of antiretroviral therapy? The IeDEA West Africa Cohort Collaboration

Bernard¹,

Balestre²,

Coffie³

et al. 2018

HIV

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BackgroundReporting mortality and lost to follow-up (LTFU) by age is essential as older HIV-positive patients might be at risk of long-term effects of living with HIV and/or taking antiretroviral therapy (ART). As age effects might not be linear and might impact HIV outcomes in the oldest more severely, people living with HIV (PLHIV) aged 50–59 years and PLHIV aged >60 years were considered separately.SettingSeventeen adult HIV/AIDS clinics spread over nine countries in West Africa.MethodsData were collected within the International Epidemiological Databases to Evaluate AIDS West Africa Collaboration. ART-naïve PLHIV-1 adults aged >16 years initiating ART and attending ≥2 clinic visits were included (N=73,525). Age was divided into five groups: 16–29/30–39/40–49/50–59/≥60 years. The age effect on mortality and LTFU was evaluated with Kaplan–Meier curves and multivariable Cox proportional hazard regressions.ResultsAt month 36, 5.9% of the patients had died and 47.3% were LTFU. Patients aged ≥60 (N=1,736) and between 50–59 years old (N=6,792) had an increased risk of death in the first 36 months on ART (adjusted hazard ratio=1.66; 95% CI: 1.36–2.03 and adjusted hazard ratio=1.31; 95% CI: 1.15–1.49, respectively; reference: <30 years old). Patients ≥60 years old tend to be more often LTFU.ConclusionThe oldest PLHIV presented the poorest outcomes, suggesting that the PLHIV aged >50 years old should not be considered as a unique group irrespective of their age. Tailored programs focusing on improving the care services for older PLHIV in Sub-Saharan Africa are clearly needed to improve basic program outcomes.

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Section: Discussionmentioning

confidence: 94%

Aging with HIV: what effect on mortality and loss to follow-up in the course of antiretroviral therapy? The IeDEA West Africa Cohort Collaboration

Bernard¹,

Balestre²,

Coffie³

et al. 2018

HIV

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“…We excluded 1589 items for the reasons detailed in Figure . Thirty articles met inclusion criteria . Two studies reported results for children and adults separately.…”

Section: Resultsmentioning

confidence: 99%

Outcomes of HIV‐positive patients lost to follow‐up in African treatment programmes

Zürcher

Mooser

Anderegg

et al. 2017

Tropical Med Int Health

113

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OBJECTIVE The retention of patients on antiretroviral therapy (ART) is key to achieving global targets in response to the HIV epidemic. Loss to follow-up (LTFU) can be substantial, with unknown outcomes for patients lost to ART programmes. We examined changes in outcomes of patients LTFU over calendar time, assessed associations with other study and programme characteristics and investigated the relative success of different tracing methods. METHODS We performed a systematic review and logistic random-effects meta-regression analysis of studies that traced adults or children who started ART and were LTFU in sub-Saharan African treatment programmes. The primary outcome was mortality, and secondary outcomes were undocumented transfer to another programme, treatment interruption and the success of tracing attempts. RESULTS We included 32 eligible studies from 12 countries in sub-Saharan Africa: 20 365 patients LTFU were traced, and 15 708 patients (77.1%) were found. Compared to telephone calls, tracing that included home visits increased the probability of success: the adjusted odds ratio (aOR) was 9.35 (95% confidence interval [CI] 1.85–47.31). The risk of death declined over calendar time (aOR per 1-year increase 0.86, 95% CI 0.78–0.95), whereas undocumented transfers (aOR 1.13, 95% CI 0.96–1.34) and treatment interruptions (aOR 1.31, 95% CI 1.18–1.45) tended to increase. Mortality was lower in urban than in rural areas (aOR 0.59, 95% CI 0.36–0.98), but there was no difference in mortality between adults and children. The CD4 cell count at the start of ART increased over time. CONCLUSIONS Mortality among HIV-positive patients who started ART in sub-Saharan Africa, were lost to programmes and were successfully traced has declined substantially during the scale-up of ART, probably driven by less severe immunodeficiency at the start of therapy.

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“…One study in Togo including 16,617 HIV-positive patients showed that 7% were lost to follow-up after initiation of treatment after 6 months. In another study, of 13,726 participants whose phone number was listed, 80% were not reachable on the known phone number [ 6 ]. In a study in Cote d’Ivoire of patients on antiretroviral therapy (ART), an attempt was made to trace approximately 7000 patients through telephone calls who were lost to follow-up.…”

Section: Introductionmentioning

confidence: 99%

Phone Calls to Retain Research Participants and Determinants of Reachability in an African Setting: Observational Study

et al. 2020

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Background Long-term retention of research participants in studies is challenging. In research in sub-Saharan Africa, phone calls are the most frequently used method to distantly engage with participants. Objective We aimed to get insight into the effectiveness of phone calls to retain contact with participants and evaluated determinants of reachability. Methods A cross-sectional study was performed using the databases of two randomized controlled trials investigating different kinds of antiretroviral therapy in HIV-positive patients. One trial finished in 2018 (study 1), and the other finished in 2015 (study 2). A random sample size of 200 participants per study was obtained. There were up to 3 phone numbers available per participant collected during the studies. Participants received a maximum of 3 phone calls on every available number on different days and at different times. Voicemails were left, and emails sent wherever possible. We documented how many calls were answered, who answered, as well as after how many attempts participants were reached. To further increase our understanding of reachability, we conducted a short questionnaire assessing factors contributing to reachability. The study was approved by the Research Ethics Committee of the University of Witwatersrand, Johannesburg, South Africa (reference number M1811107). Results In our sample size of n=200 per study, study 1, with a median time of 11 months since the last visit at the research site, had a response rate of 70.5% (141/200) participants while study 2, with a median duration of 55 months since the last visit, had a response rate of 50.0% (100/200; P<.001). In study 1, 61.5% (123/200) of calls were answered directly by the participant while this was 36.0% (72/200) in study 2 (P=.003). The likelihood of reaching a participant decreased with time (odds ratio [OR] 0.73, 95% CI 0.63 to 0.84) for every year since the last face-to-face visit. Having more phone numbers per participant increased reachability (OR 2.32, 95% CI 1.24 to 4.36 for 2 phone numbers and OR 3.03, 95% CI 1.48 to 6.22 for 3 phone numbers compared with 1 number). A total of 141 of 241 reached participants responded to the questionnaire. Of the 93 participants who had changed phone numbers, 5% (50/93) had changed numbers because their phone was stolen. The most preferred method of being contacted was direct calling (128/141) with participants naming this method followed by WhatsApp (69/141). Conclusions Time since last visit and the number of phone numbers listed were the only determinants of reachability. Longer follow-up time is accompanied with a decrease in reachability by phone while more listed phone numbers increases the likelihood that someone can be reached. Trial Registration ClinicalTrials.gov NCT02671383; https://clinicaltrials.gov/ct2/show/NCT02671383 and ClinicalTrials.gov NCT02670772; https://clinicaltrials.gov/ct2/show/NCT02670772

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Loss of HIV-infected patients on potent antiretroviral therapy programs in Togo: risk factors and the fate of these patients

Cited by 21 publications

References 19 publications

Aging with HIV: what effect on mortality and loss to follow-up in the course of antiretroviral therapy? The IeDEA West Africa Cohort Collaboration

Aging with HIV: what effect on mortality and loss to follow-up in the course of antiretroviral therapy? The IeDEA West Africa Cohort Collaboration

Outcomes of HIV‐positive patients lost to follow‐up in African treatment programmes

Phone Calls to Retain Research Participants and Determinants of Reachability in an African Setting: Observational Study

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