Loss to follow-up occurs at all stages in the diagnostic and follow-up period among HIV-infected patients in Guinea-Bissau: a 7-year retrospective cohort study

Hønge, Bo Langhoff; Jespersen, Sanne; Nordentoft, Pernille Bejer; Medina, Candida; Silva, David Da; Silva, Zacarias José da; Østergaard, Lars; Laursen, Alex Lund; Wejse, Christian

doi:10.1136/bmjopen-2013-003499

Cited by 91 publications

(93 citation statements)

References 39 publications

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“…When compared to findings elsewhere in Ethiopia, discontinuation rate in the current study was higher than findings from the Tigray’s study [14] and lower than findings from the Amhara’s study [15]. In addition, this rate was lower than findings from studies conducted in Guinea-Bissau (51.1%)[39], Nigeria (28%)[40], and a multi-clinic study from Republic of Congo, Cameron and Burundi (83%)[41]. The dissimilarity in measurement[42], access to HIV care services[43], and innovation, adoption and implementation of cost-effective retention strategies could be the possible reasons of differences[44, 45].…”

Section: Discussioncontrasting

confidence: 84%

Prevalence, trend and risk factors for antiretroviral therapy discontinuation among HIV-infected adults in Ethiopia in 2003-2015

et al. 2017

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BackgroundIt is well acknowledged that antiretroviral therapy (ART) discontinuation hampers the progress towards achieving the UNAIDS treatment targets that aim to treat 90% of HIV diagnosed patients and achieve viral suppression for 90% of those on treatment. Nevertheless, the magnitude, trend and risk factors for ART discontinuation have not been explored extensively. We carried out a retrospective data analysis to assess prevalence, trend and risk factors for ART discontinuation among adults in Southwest Ethiopia.Methods12 years retrospective cohort analysis was performed with 4900 HIV-infected adult patients between 21 June 2003 and 15 March 2015 registered at the ART clinic at Jimma University Teaching Hospital. ART discontinuation could be loss to follow-up, defaulting and/or stopping medication while remaining in care. Because data for 2003 and 2015 were incomplete, the 10 years data were used to describe trends for ART discontinuation using a line graph. We used binary logistic regression to identify factors that were correlated with ART discontinuation. To handle missing data, we applied multiple imputations assuming missing at random pattern.ResultsIn total, 4900 adult patients enrolled on ART, of whom 1090 (22.3%) had discontinued, 954 (19.5%) had transferred out, 300 (6.1%) had died, 2517 (51.4%) were alive and on ART, and the remaining 39 (0.8%) had unknown outcome status. The trend of ART discontinuation showed an upward direction in the recent times and reached a peak, accounting for a magnitude of 10%, in 2004 and 2005. Being a female (AOR = 2.1, 95%CI: 1.7–2.8), having an immunological failure (AOR = 2.3, 1.9–8.2), having tuberculosis/HIV co-infection (AOR = 1.5, 1.1–2.1) and no previous history of HIV testing (AOR = 1.8, 1.4–2.9) were the risk factors for ART discontinuation.ConclusionsOne out of five adults had discontinued from ART, and the trend of ART discontinuation increased recently. Discontinued adults were more likely to be females, tuberculosis/HIV co-infected, with immunological failure and no history of HIV testing. Therefore, it is vital to implement effective programs such as community ART distribution and linkage-case-management to enhance ART linkage and retention.

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Section: Discussioncontrasting

confidence: 84%

Prevalence, trend and risk factors for antiretroviral therapy discontinuation among HIV-infected adults in Ethiopia in 2003-2015

et al. 2017

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“…This lack probably led to an underestimation of the prevalence of treatment failure since patients for whom failure was not assessable may be a subgroup with poor healthcare-seeking behaviour. The HIV clinic in Bissau has a high rate of LTFU [9], and mortality may have been underestimated because some of the patients classified as LTFU may have in fact died [11]. …”

Section: Discussionmentioning

confidence: 99%

“…Patients on ART were considered lost to follow-up (LTFU) if they had not visited the clinic for six months. Information on death and transfer to other ART centres was collected by personal information, telephone calls with contact persons or from the hospital wards [9]. …”

Section: Methodsmentioning

confidence: 99%

Lack of awareness of treatment failure among HIV‐1‐infected patients in Guinea‐Bissau – a retrospective cohort study

Jespersen

Hønge

Medina

et al. 2015

Journal of the International AIDS Society

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IntroductionWith more people receiving antiretroviral treatment (ART), the need to detect treatment failure and switch to second-line ART has also increased. We assessed CD4 cell counts (as a marker of treatment failure), determined the rate of switching to second-line treatment and evaluated mortality related to treatment failure among HIV-infected patients in Guinea-Bissau.MethodsIn this retrospective cohort study, adult patients infected with HIV-1 receiving ≥6 months of ART at an HIV clinic in Bissau were included from June 2005 to July 2014 and followed until January 2015. Treatment failure was defined as 1) a fall in CD4 count to baseline (or below) or 2) CD4 levels persistently below 100 cells/µL after ≥6 months of ART. Cox hazard models, with time since six months of ART as the time-varying coefficient, were used to estimate the hazard ratio for death and loss to follow-up.ResultsWe assessed 1,591 HIV-1-infected patients for immunological treatment failure. Treatment failure could not be determined in 594 patients (37.3%) because of missing CD4 cell counts. Among the remaining 997 patients, 393 (39.4%) experienced failure. Only 39 patients (9.9%) with failure were switched from first- to second-line ART. The overall switching rate was 3.1 per 100 person-years. Mortality rate was higher in patients with than without treatment failure, with adjusted hazard rate ratios (HRRs) 10.0 (95% CI: 0.9–107.8), 7.6 (95% CI: 1.6–35.5) and 3.1 (95% CI: 1.5–6.3) in the first, second and following years, respectively. During the first year of follow-up, patients experiencing treatment failure had a higher risk of being lost to follow-up than patients not experiencing treatment failure (adjusted HRR 4.4; 95% CI: 1.7–11.8).ConclusionsWe found a high rate of treatment failure, an alarmingly high number of patients for whom treatment failure could not be assessed, and a low rate of switching to a second-line therapy. These factors could lead to an increased risk of resistance development and excess mortality.

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“…Studies in high-income countries have demonstrated increased risk of mortality among HIV-infected persons living below the poverty line 4 and in neighborhoods with lower average annual income, 5 though the latter relationship was largely accounted for by differential access to antiretroviral therapy (ART). In addition to mortality, LTFU has emerged as a key outcome in HIV treatment given the high rates of LTFU across stages 6 of clinic enrollment, pre-ART evaluation, and ART adherence observed in SSA 7–9 . To the best of our knowledge, studies evaluating the relationship between SES and long-term mortality or LTFU have not been replicated in Sub-Saharan Africa (SSA).…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic Determinants of Mortality in HIV

Burkey

Weiser

Fehmie

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Objective To delineate the association between baseline socioeconomic status (SES) indicators and mortality and lost to follow-up (LTFU) in a cohort of HIV-infected individuals enrolled in antiretroviral treatment (ART) in urban Uganda. Design Retrospective cohort study nested in an antiretroviral clinic-based cohort. Methods SES indicators including education, employment status, and a standardized wealth index, and other demographic and clinical variables were assessed at baseline among ART-treated patients in a clinic-based cohort in Kampala, Uganda. Confirmed mortality (primary outcome) and LTFU (secondary outcome) were actively ascertained over a 4-year follow-up period from 2005–2009. Results Among 1763 adults (70.5% female; mean age 36.2 years (SD=8.4)) enrolled in ART, 14.4% (n=253) were confirmed dead and 19.7% (n=346) were LTFU at 4-year follow-up. No formal education (Adjusted Odds Ratio (AOR) 1.76; 95% Confidence Interval (CI): 1.19 to 2.59), having fewer than 6 dependents (AOR 1.39; 95% CI: 1.04 to 1.86), unemployment (AOR 1.98; 95% CI: 1.48 to 2.66) and housing tenure index score (a component of the wealth index) (AOR 1.11; 95% CI: 1.00 to 1.23) were significantly associated with confirmed mortality at 4 years. SES indicators were not associated with LFTU at 4 years. Conclusions Baseline SES indicators, including education, number of dependents, employment status, and components of a standard wealth index, may indicate long-term vulnerability to mortality in patients with HIV/AIDS, despite uniform access to ART. Future studies delineating the pathways through which poverty and limited assets affect clinical outcomes may lead to more effective HIV interventions in low-resource settings.

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Loss to follow-up occurs at all stages in the diagnostic and follow-up period among HIV-infected patients in Guinea-Bissau: a 7-year retrospective cohort study

Cited by 91 publications

References 39 publications

Prevalence, trend and risk factors for antiretroviral therapy discontinuation among HIV-infected adults in Ethiopia in 2003-2015

Prevalence, trend and risk factors for antiretroviral therapy discontinuation among HIV-infected adults in Ethiopia in 2003-2015

Lack of awareness of treatment failure among HIV‐1‐infected patients in Guinea‐Bissau – a retrospective cohort study

Socioeconomic Determinants of Mortality in HIV

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