Outcomes of antiretroviral therapy among younger versus older adolescents and adults in an urban clinic, Zimbabwe

Matyanga, C. M. J.; Takarinda, Kudakwashe C; Owiti, Philip; Mutasa‐Apollo, Tsitsi; Mugurungi, Owen; Buruwe, L.; Reid, Anthony

doi:10.5588/pha.15.0077

Cited by 20 publications

(25 citation statements)

References 21 publications

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“…We found that adolescents and young adults were more at risk of attrition when compared to adults. Our findings are consistent with other studies [49][50][51][52]. Adolescents and young adults have been shown to be at high risk of attrition due to several factors, which include lack of youth-friendly services, rigid scheduling not taking into account schooling, and unavailability of peer caregivers [53,54].…”

Section: Discussionsupporting

confidence: 92%

Retention and predictors of attrition among patients who started antiretroviral therapy in Zimbabwe’s national antiretroviral therapy programme between 2012 and 2015

et al. 2020

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Background The last evaluation to assess outcomes for patients receiving antiretroviral therapy (ART) through the Zimbabwe public sector was conducted in 2011, covering the 2007-2010 cohorts. The reported retention at 6, 12, 24 and 36 months were 90.7%, 78.1%, 68.8% and 64.4%, respectively. We report findings of a follow-up evaluation for the 2012-2015 cohorts to assess the implementation and impact of recommendations from this prior evaluation. Methods A nationwide retrospective study was conducted in 2016. Multi-stage proportional sampling was used to select health facilities and study participants records. The data extracted from patient manual records included demographic, baseline clinical characteristics and patient outcomes (active on treatment, died, transferred out, stopped ART and lost to follow-up (LTFU)) at 6, 12, 24 and 36 months. The data were analysed using Stata/IC 14.2. Retention was estimated using survival analysis. The predictors associated with attrition were determined using a multivariate Cox regression model. Results A total of 3,810 participants were recruited in the study. The median age in years was 35 (IQR: 28-42). Overall, retention increased to 92.4% (p-value = 0.060), 86.5% (p-value<0.001), 79.2% (p-value<0.001) and 74.4% (p-value<0.001) at 6, 12, 24 and 36 months respectively. LTFU accounted for 98% of attrition. Being an adolescent or a young adult (15-24 years) (vs adult;1.41; 95% CI:1.14-1.74), children (<15years) (vs adults; aHR

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Section: Discussionsupporting

confidence: 92%

Retention and predictors of attrition among patients who started antiretroviral therapy in Zimbabwe’s national antiretroviral therapy programme between 2012 and 2015

et al. 2020

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“…The peak in attrition during the first six months on ART across all CD4 strata emphasises the need for additional retention strategies at clinics during early ART. [ 8 , 9 , 25 – 27 ]The higher attrition amongst younger clients (18 to 25 years) is in keeping with previously published data and highlights the need to continue to strengthen interventions and support focused on this age group [ 28 , 29 ]. Attrition was also higher amongst clients starting ART in 2015 compared to 2014.…”

Section: Discussionsupporting

confidence: 74%

Attrition when providing antiretroviral treatment at CD4 counts >500cells/μL at three government clinics included in the HPTN 071 (PopART) trial in South Africa

et al. 2018

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IntroductionWHO recommends antiretroviral treatment (ART) for all HIV-positive individuals. This study evaluated the association between baseline CD4 count and attrition in a cohort of HIV positive adults initiating ART at three department of health (DOH) clinics routinely providing ART at baseline CD4 counts >500cells/μL for the HPTN 071 (PopART) trial.MethodsAll clients attending the DOH clinics were managed according to standard care guidelines with the exception that those starting ART outside of pertinent local guidelines signed research informed consent. DOH data on all HIV-positive adult clients recorded as having initiated ART between January 2014 and November 2015 at the three study clinics was analysed. Attrition, included clients lost to follow up or died, and was defined as ‘being three or more months late for an antiretroviral pharmacy pick-up appointment’. All clients were followed until attrition, transfer out or end May 2016.ResultsA total of 2423 clients with a median baseline CD4 count of 328 cells/μL (IQR 195–468) were included of whom 631 (26.0%) experienced attrition and 140 (5.8%) were TFO. Attrition was highest during the first six months of ART (IR 38.3/100 PY; 95% CI 34.8–42.1). Higher attrition was found amongst those with baseline CD4 counts > 500 cells/μL compared to those with baseline CD4 counts of 0–500 cells/μL (aHR 1.26, 95%CI 1.05 to 1.52) This finding was confirmed on subset analyses when restricted to individuals non-pregnant at baseline and when restricted to individuals with follow up of > 12months.ConclusionsAttrition in this study was high, particularly during the first six months of treatment. Attrition was highest amongst clients starting ART at baseline CD4 counts > 500 cells/μL. Strategies to improve retention amongst ART clients, particularly those starting ART at baseline CD4 counts >500cells/μL, need strengthening. Improved monitoring of clients moving in and out of ART care and between clinics will assist in better understanding attrition and ART coverage in high burden countries.

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“…Some studies in sub-Saharan Africa identified the same baseline characteristics that predicted attrition in our analysis (younger age [32] and male gender [35]). Our finding that retention on ART is particularly low in adolescents was also highlighted by other studies from Sub-Saharan Africa [36][37][38][39].…”

Section: Discussionsupporting

confidence: 86%

Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study

Mugglin

Haas

Oosterhout

et al. 2019

Preprint

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Objectives: We examine long-term retention of adults, adolescents and children on antiretroviral therapy under different HIV treatment guidelines in Malawi. Design: Prospective cohort study. Setting and participants: Adults and children starting ART between 2005 and 2015 in 21 health facilities in southern Malawi. Methods: We used survival analysis to assess retention at clinic level, Cox regression to examine risk factors for loss to follow up, and competing risk analysis to assess long-term outcomes of people on antiretroviral therapy (ART). Results: We included 132,274 individuals in our analysis, totalling 270,256 person years of follow up (PYFU; median per patient 1.3, interquartile range (IQR) 0.26-3.1), 62% were female and the median age was 32 years. Retention on ART was lower in the first year on ART compared to subsequent years for all guideline periods and age groups. Infants (0-3 years), adolescents and young adults (15-24 years) were at highest risk of LTFU. Comparing the different calendar periods of ART initiation we found that retention improved initially, but remained stable thereafter. Conclusion: Even though the number of patients and the burden on health care system increased substantially during the study period of rapid ART expansion, retention on ART improved in the early years of ART provision, but gains in retention were not maintained over 5 years on ART. Reducing high attrition in the first year of ART should remain a priority for ART programs, and so should addressing poor retention among adolescents, young adults and men.

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Outcomes of antiretroviral therapy among younger versus older adolescents and adults in an urban clinic, Zimbabwe

Cited by 20 publications

References 21 publications

Retention and predictors of attrition among patients who started antiretroviral therapy in Zimbabwe’s national antiretroviral therapy programme between 2012 and 2015

Retention and predictors of attrition among patients who started antiretroviral therapy in Zimbabwe’s national antiretroviral therapy programme between 2012 and 2015

Attrition when providing antiretroviral treatment at CD4 counts >500cells/μL at three government clinics included in the HPTN 071 (PopART) trial in South Africa

Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study

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