Mortality and loss-to-follow-up during the pre-treatment period in an antiretroviral therapy programme under normal health service conditions in Uganda

Amuron, Barbara; Namara, Geoffrey; Birungi, Josephine; Nabiryo, Christine; Levin, Jonathan; Grosskurth, Heiner; Coutinho, Alex; Jaffar, Shabbar

doi:10.1186/1471-2458-9-290

Cited by 149 publications

(171 citation statements)

References 16 publications

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“…Patients who are not yet eligible for ART will generally not have undergone ART adherence counselling, and because they perceive themselves as well they may have irregular review visits, leading to IPT non-completion. Several studies support this supposition, showing high rates of loss to follow-up in pre-ART care in sub-Saharan Africa, [25][26][27] and therefore a need for enhanced counselling on the benefits of IPT among these PLHIV.…”

Section: Public Health Action Ipt In Zimbabwe 58mentioning

confidence: 98%

“…This initiative requires further implementation research. del 95% 0,03-0,28) y el hecho de recibir una reserva de isoniazida para 2 meses al comienzo del ciclo, y el factor que se asoció con un mayor riesgo de no finalizar el tratamiento fue cuando el paciente había incumplido citas médicas antes de comenzar el tratamiento (ORa 5,25; IC95% 2,(10)(11)(12)(13)14). Conclusión: Las tasas de finalización del TPI en los siete centros pilotos de Zimbabue fueron relativamente altas e indican que es factible desplegar esta iniciativa en los establecimientos públicos de salud.…”

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Routine implementation of isoniazid preventive therapy in HIV-infected patients in seven pilot sites in Zimbabwe

Takarinda

Choto

Harries

et al. 2017

public health action

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Setting: Seven pilot sites in Zimbabwe implementing 6 months of isoniazid preventive therapy (IPT) for people living with the human immunodeficiency virus (PLHIV). Objectives: To determine, among PLHIV started on IPT, the completion rates for a 6-month course of IPT and factors associated with non-adherence. Design: A retrospective cohort study. Results: Of 578 patients, 466 (81%) completed IPT. Of the 112 patients who failed to complete IPT, 69 (60%) were lost to follow-up, 30 (27%) stopped treatment with no documented reasons, 8 (7%) developed toxicity/adverse reactions, 5 (5%) were documented as having drug stock-outs and the remainder transferred out or refused to continue treatment. Currently being on antiretroviral therapy (ART) (aOR 0.09, 95%CI 0.03-0.28) and receiving a 2 month supply of isoniazid at the start of treatment were associated with a lower risk of not completing IPT, while missing clinic visits prior to starting IPT (aOR 5.25, 95%CI 2.10-13.14) was associated with a higher risk of non-completion. Conclusion: IPT completion rates in seven pilot sites of Zimbabwe were comparatively high, showing that IPT roll-out in public health facilities is feasible. Enhanced adherence counselling or active tracing among pre-ART patients and those with a history of loss to follow-up may improve IPT completion rates, along with synchronising IPT and ART resupplies. Public Health Action IPT in Zimbabwe 56the WHO-recommended four-symptom TB screening checklist. 11 If PLHIV present with any of the four symptoms, they are considered to be presumptive TB cases and sputum specimens are collected for smear microscopy or Xpert ® MTB/RIF (Cepheid, Sunnyvale, CA, USA) testing. Those patients negative on Xpert or smear microscopy and who have no other symptoms or signs of extra-pulmonary or smear-negative pulmonary TB, including chest radiography if necessary, are not recorded as having active TB. During the pilot phase, PLHIV who were not diagnosed with active TB were offered adherence counselling and were started on a daily oral dose of isoniazid (INH, 5 mg/kg body weight for adults or 10 mg/kg body weight for children) plus a daily low dose of pyridoxine (25 mg/day) for a 6-month period, regardless of their ART status. It was recommended that patients receive regular supplies of INH every month until completion of their prophylactic treatment. 10 During clinic visits, patients were assessed through self-reporting and pill counts for adherence and screened for TB. Patients found to have active TB were taken off IPT and treated according to the national TB guidelines. 11 Data on TB status (screened with no TB signs/not screened/ presumptive TB case/active TB), IPT status (yes/no), IPT quantity dispensed and reasons for starting or stopping IPT were integrated into the individual patient opportunistic infection (OI) ART care booklets and the pre-ART or ART registers, depending on the patients' ART status. This information was updated during each clinical review visit. For easier tracing of all clients enrolled on IPT, ...

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Section: Public Health Action Ipt In Zimbabwe 58mentioning

confidence: 98%

unclassified

Routine implementation of isoniazid preventive therapy in HIV-infected patients in seven pilot sites in Zimbabwe

Takarinda

Choto

Harries

et al. 2017

public health action

View full text Add to dashboard Cite

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“…More recently in South Africa, having a regular partner was found to be factor associated with ART initiation [7]. Studies from Uganda [19] and Malawi [20] suggest that ART uptake is influenced by patient acceptance of their HIV-positive status, disclosure, and preparation for ART initiation. These differences may be due to socioeconomic factors and ART guidelines that are inherent to each country.…”

Section: Discussionmentioning

confidence: 99%

“…However, our finding that education increases the likelihood of ART initiation is consistent with regional findings on the individual and service-level factors that influence patient during counseling period. Studies from Ethiopia [21], Uganda [22], rural Malawi and Zimbabwe [23] suggest that ART uptake is influenced by patient acceptance of their HIV-positive status, disclosure, and preparation for ART initiation. Among healthcare factors, patients from a South African clinic who returned for one or more routine HIV counseling visits and had multiple exposures to health care providers appeared to increase patient motivation and reject common myths about ART reducing delays in ART initiation [24].…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with the Acceptance of Immediate Antiretroviral Therapy after HIV Diagnosis in Thai Cohort

Kingkaew¹,

Kanchanatawan²,

Teeratakulpisarn³

et al. 2017

UCMS

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BACKGROUND: Since 2014, Thailand has recommend initiation of antiretroviral therapy (ART) immediately after HIV diagnosis, regardless of CD4 count. HIV treatment can prevent illnesses and deaths, avert new infections, and save costs. Achieving UNAIDS 90-90-90 targets by 2020 will enable Thailand to end the AIDS epidemic by 2030. Therefore, patients immediate consent to treatment to immediate ART treatment in people recently diagnosed with HIV are key to successful ART initiation and long-term adherence. We studied factors associated with acceptance of ART initiation among Thai people promptly after their HIV diagnoses. OBJECTIVES: To examine the prevalence and associated factors of consent to immediate initiation of antiretroviral therapy after HIV diagnosis among HIV-positive Thai patients. DESIGN: A cross-sectional descriptive study. SETTING: Anonymous Clinic, Thai Red Cross AIDS Research Centre. MATERIAL AND METHODS: This research is combination of quantitative and qualitative cross-sectional data collected for the purpose of identifying acceptance levels and associated factors with the initiation of ART treatment among people infected. A total of 216 participants were included in the study. Self-administered questionnaire and in-depth interviews were used to collect data from clients 18 years. Binary logistic regression was performed to assess factors related to immediate ART acceptance. RESULTS: Enrollment of participants was 216 and 95.40% indicating they were prepared to start ART immediately and had demonstrated acceptance of their condition and 4.60% chose to defer. 61% were men who have sex with men, 31% were heterosexual, 2% were transgender women and 6% were bisexual men. Median (IQR) age was 29 (24-36) years; median (IQR) CD4 count was 274 (168-396) cells per cubic millimeter. 72% had unprotected sex over the past 6 months, and 9% had HIV-associated symptoms/AIDS-defining illness. Median (IQR) HIV knowledge score was 12 out of 15 (11-13.5), 74% were aware of possible adverse health outcomes and 85% knew about resistance development as a result of poor ART adherence. Multivariable analysis showed that education equal or higher than bachelor's degree increased acceptance of immediate ART initiation (aOR 0.71, 95%CI 0.008-0.645, P = 0.01). Having STI (aOR 7.822, 95%CI 1.374-44.534, P = 0.02) and obligation (aOR 0.157, 95%CI 0.032-0.770, P = 0.02) were significantly associated with ART acceptance. CONCLUSION: Acceptance of immediate ART after HIV diagnosis was very high among newly diagnosed HIV-positive clients at the Thai Red Cross Anonymous Clinic. Education, experience of STI and obligation consequences influenced ART acceptance.

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“…Of lostto-follow-up (LTFU) pre-ART patients in Jinja, Uganda, 28% died within 1 year of last attendance. 9 A 21% mortality rate was identified among LTFU patients from a large clinic in Johannesburg. 10 An efficient way to identify and attend to service gaps is to investigate LTFU patients.…”

mentioning

confidence: 99%

Recall of lost-to-follow-up pre-antiretroviral therapy patients in the Eastern Cape: Effect of mentoring on patient care

et al. 2012

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Mortality and loss-to-follow-up during the pre-treatment period in an antiretroviral therapy programme under normal health service conditions in Uganda

Cited by 149 publications

References 16 publications

Routine implementation of isoniazid preventive therapy in HIV-infected patients in seven pilot sites in Zimbabwe

Routine implementation of isoniazid preventive therapy in HIV-infected patients in seven pilot sites in Zimbabwe

Factors Associated with the Acceptance of Immediate Antiretroviral Therapy after HIV Diagnosis in Thai Cohort

Recall of lost-to-follow-up pre-antiretroviral therapy patients in the Eastern Cape: Effect of mentoring on patient care

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