Predictors of Attrition and Immunological Failure in HIV-1 Patients on Highly Active Antiretroviral Therapy from Different Healthcare Settings in Mozambique

Abstract

In Mozambique, the evaluation of retention in HIV care and ART programmes is limited. To assess rate and predictors of attrition (no retention in care) and HAART effectiveness in HIV-1 infected patients who pay for medication and laboratory testing in Mozambique, we conducted a multicenter survey of HIV-1-infected patients who started HAART during 2002–2006. Cox proportional hazard models were used to assess risk of attrition and of therapy failure. Overall, 142 patients from 16 healthcare centers located in the capital city Maputo were followed-up for 22.2 months (12.1–46.7). The retention rate was 75%, 48% and 37% after one, two and three years, respectively. Risk of attrition was lower in patients with higher baseline CD4 count (P = 0.022) and attending healthcare center 1 (HCC1) (P = 0.013). The proportion of individuals with CD4 count ≤200 cells/µL was 55% (78/142) at baseline and decreased to 6% (3/52) at 36 months. Among the patients with available VL, 86% (64/74) achieved undetectable VL levels. The rate of immunologic failure was 17.2% (95% CI: 12.6–22.9) per 100 person-years. Risk of failure was associated to higher baseline CD4 count (P = 0.002), likely reflecting low adherence levels, and decreased with baseline VL ≥10,000 copies/mL (P = 0.033). These results suggest that HAART can be effective in HIV-1 infected patients from Mozambique that pay for their medication and laboratory testing. Further studies are required to identify the causes for low retention rates in patients with low CD4 counts and to better understand the association between healthcare setting and attrition rate.

Prevalence and Predictors of Immunological Failure among HIV Patients on HAART in Southern Ethiopia

“…Findings of no association were similar with respect to age, gender, tuberculosis, and treatment interruption. In the Mozambique study, the CD4 cell count association was similar to findings form the current study [ 43 ]. The fact that there was no association between adherence to antiretroviral medication refill and immunological treatment failure was a surprising finding.…”

Predictors of Treatment Failure among Adult Antiretroviral Treatment (ART) Clients in Bale Zone Hospitals, South Eastern Ethiopia

“…This incidence rate is relatively low as compared to the incidence rate reported by different studies in Ethiopia and abroad [ 10 , 14 , 15 ]. A study from Mozambique reported that rate of immunologic failure was 17.2 (95% CI: 12.6–22.9) per 100 person-years of follow-up [ 16 ]. Another study from Thailand showed that 4.3%, 10.7%, and 4.9% met the criteria of virological failure, immunological failure, and clinical failure, respectively.…”

Predictors of first-line antiretroviral therapy failure amongst HIV-infected adult clients at Woldia Hospital, Northeast Ethiopia

“…The study on fee based ART program in Mozambique showed that, the risk of failure was higher among patients with a high baseline CD 4 cell count and low baseline viral load. The result reflected that these groups of patients might have low adherence level due to the lower risk of developing opportunistic infections [ 26 , 27 ]. Contrary to these findings, a low rate of immunologic treatment failure was reported from a study in India [ 28 ].…”