Patients’ demographic and clinical characteristics and level of care associated with lost to follow‐up and mortality in adult patients on first‐line ART in Nigerian hospitals

Abstract

IntroductionClinical outcome is an important determinant of programme success. This study aims to evaluate patients’ baseline characteristics as well as level of care associated with lost to follow-up (LTFU) and mortality of patients on antiretroviral treatment (ART).MethodsRetrospective cohort study using routine service data of adult patients initiated on ART in 2007 in 10 selected hospitals in Nigeria. We captured data using an electronic medical record system and analyzed using Stata. Outcome measures were probability of being alive and retained in care at 12, 24 and 36 months on ART. Potential predictors associated with time to mortality and time to LTFU were assessed using competing risks regression models.ResultsAfter 12 months on therapy, 85% of patients were alive and on ART. Survival decreased to 81.2% and 76.1% at 24 and 36 months, respectively. Median CD4 count for patients at ART start, 12, 18 and 24 months were 152 (interquartile range, IQR: 75 to 242), 312 (IQR: 194 to 450), 344 (IQR: 227 to 501) and 372 (IQR: 246 to 517) cells/µl, respectively. Competing risk regression showed that patients’ baseline characteristics significantly associated with LTFU were male (adjusted sub-hazard ratio, sHR=1.24 [95% CI: 1.08 to 1.42]), ambulatory functional status (adjusted sHR=1.25 [95% CI: 1.01 to 1.54]), World Health Organization (WHO) clinical Stage II (adjusted sHR=1.31 [95% CI: 1.08 to 1.59]) and care in a secondary site (adjusted sHR=0.76 [95% CI: 0.66 to 0.87]). Those associated with mortality include CD4 count <50 cells/µl (adjusted sHR=2.84 [95% CI: 1.20 to 6.71]), WHO clinical Stage III (adjusted sHR=2.67 [95% CI: 1.26 to 5.65]) and Stage IV (adjusted sHR=5.04 [95% CI: 1.93 to 13.16]) and care in a secondary site (adjusted sHR=2.21 [95% CI: 1.30 to 3.77]).ConclusionsMortality was associated with advanced HIV disease and care in secondary facilities. Earlier initiation of therapy and strengthening systems in secondary level facilities may improve retention and ultimately contribute to better clinical outcomes.

Mortality predictors of HIV-infected patients on antiretroviral therapy in Debre Tabor General Hospital and Woreta Health Center, South Gondar Zone, Northwest Ethiopia

“…In addition, tuberculosis was found to be the most important cause of death and it caused 48% of the total death and other studies also showed greater estimate than this current findings [15,[18][19][20][21][22][23].…”

Structure and quality of outpatient care for people living with an HIV infection

“…The majority were retrospective cohort (n = 12) (Assefa et al, 2012;Backus et al, 2010;Chan et al, 2011;Chu, Umanski, Blank, Grossberg, & Selwyn, 2010;Fatti, Grimwood, & Bock, 2010;Kerr et al, 2012;Kitahata et al, 2003;Landon et al, 2005;Odafe, Idoko, et al, 2012;Odafe, Torpey, et al, 2012;Sherr et al, 2010;Solomon, Flynn, & Lavetsky, 2005) or cross-sectional studies (n = 7) (Anaya, Yano, & Asch, 2004;Boyer et al, 2011;Horberg, Hurley, Silverberg, Kinsman, & Quesenberry, 2007;Saha et al, 2013;Shet et al, 2011;Wilson, Landon, Hirschhorn, et al, 2005). One study had a prospective cohort design (Sangsari et al, 2012), and eight studies did not explicitly state their design strategy.…”

“…One study had a prospective cohort design (Sangsari et al, 2012), and eight studies did not explicitly state their design strategy. Most of the studies had taken place in the USA (n = 12) (Anaya et al, 2004;Backus et al, 2010;Chu et al, 2010;Horberg et al, 2007;Kerr et al, 2012;Kitahata et al, 2003;Landon et al, 2005;Rodriguez, Marsden, Landon, Wilson, & Cleary, 2008;Saha et al, 2013;Solomon et al, 2005;Wilson, Landon, Hirschhorn, et al, 2005) and countries in sub-Saharan Africa (n = 13) (Assefa et al, 2012;Balcha & Jeppsson, 2010;Boyer et al, 2010Boyer et al, , 2011Chan et al, 2011;Ekouevi et al, 2012;Fatti et al, 2010;Fatti, Grimwood, Mothibi, & Shea, 2011;McGuire et al, 2012;Odafe, Idoko, et al, 2012;Odafe, Torpey, et al, 2012;Reidy et al, 2014;Sherr et al, 2010). The remaining studies were situated in Brazil (Nemes et al, 2009), India (Shet et al, 2011), and Canada (Sangsari et al, 2012) (Figure 1).…”

“…These studies assessed the impact of private versus public funding (Boyer et al, 2011;Ekouevi et al, 2012;Shet et al, 2011), level of care (primary/secondary/tertiary; hospital/clinic; or centralized/decentralized) (Assefa et al, 2012;Balcha & Jeppsson, 2010;Boyer et al, 2010Boyer et al, , 2011Chan et al, 2011;Ekouevi et al, 2012;Fatti et al, 2010;McGuire et al, 2012;Odafe, Idoko, et al, 2012;Odafe, Torpey, et al, 2012;Reidy et al, 2014), and location of care site (urban/rural) (Anaya et al, 2004;Balcha & Jeppsson, 2010;Boyer et al, 2010;Ekouevi et al, 2012).…”

“…Most of the studies defined LTFU as absence from treatment for at least 3 months after the last missed appointment date (Fatti et al, 2010(Fatti et al, , 2011Odafe, Idoko, et al, 2012; Odafe, Torpey, Table 2. Summary of assessed quality of care measures (n = 28).…”