Retention and attrition during the preparation phase and after start of antiretroviral treatment in Thyolo, Malawi, and Kibera, Kenya: implications for programmes?

Zachariah, Rony; Tayler‐Smith, Katie; Manzi, Marcel; Massaquoi, Moses; Mwagomba, Beatrice; Griensven, Johan van; Engelgem, Ian Van; Arnould, Line; Schouten, EJ; Chimbwandira, FM; Harries, A. D.

doi:10.1016/j.trstmh.2011.04.014

Cited by 44 publications

(43 citation statements)

References 20 publications

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“…The higher rate of LTF in pre-ART patients is consistent with previous findings from adult cohorts in SSA, which have shown greater loss of patients before ART initiation [23-25]. Rates of LTF among adolescents and youth before ART initiation have not been widely reported; however, on ART LTF reported from this cohort is somewhat higher than other cohorts of youth and adolescents [8,11], and is also higher than LTF reported for Kenyan adult cohorts [26,27]. We report LTF among all patients 10–24 years enrolled in care, including those who never returned after the first visit; and our estimates may therefore be a more accurate reflection of LTF in care programs.…”

Section: Discussionsupporting

confidence: 87%

Characteristics and outcomes of HIV-infected youth and young adolescents enrolled in HIV care in Kenya

Koech¹,

Teasdale²,

Wang³

et al. 2014

Aids

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Background The number of youth and adolescents (10–24 years) with HIV infection has increased substantially presenting unique challenges to effective health service delivery. Methods We examined routinely collected patient-level data for antiretroviral treatment (ART)-naive HIV-infected patients, aged 10–24 years, enrolled in care during 2006–2011 at 109 ICAP-supported health facilities in three provinces in Kenya. Loss to follow-up (LTF) was defined as having no clinic visit for 12 months prior to ART initiation (pre-ART) and 6 months for ART patients. Competing risk and Kaplan–Meier estimators were used to calculate LTF and death rates. Sub-distributional and Cox proportional-hazards models were used to identify potential predictors of death and LTF. Results Overall 22 832 patients were enrolled in care at 10–24 years of age, 69.5% were aged 20–24 years, and 82% were female. Median CD4+ cell count was 332 cells/μl (interquartile range 153–561); 70.8% were WHO stage I/II. Young adolescents (10–14 years) had more advanced WHO stage and lower median CD4+ cell count compared to youth (15–24 years) at enrollment (284 vs. 340 cells/μl; P <0.0001). Cumulative incidence of LTF and death at 24 months for pre-ART patients was 46.1% [95% confidence interval (CI) 45.4–46.8%) and 2.1% (95% CI 1.9–2.3%), respectively. For those on ART, 32.2% (95% CI 31.1–33.3%) were LTF and 3.9% (95% CI 1.7–2.3%) died within 24 months. LTF among pre-ART and ART patients was twice as high among youth compared to young adolescents. Conclusion LTF of young people with HIV in this Kenyan cohort was high and notably greater among youth compared to young adolescents. Novel strategies targeting these populations are urgently needed to improve retention.

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Section: Discussionsupporting

confidence: 87%

Characteristics and outcomes of HIV-infected youth and young adolescents enrolled in HIV care in Kenya

Koech¹,

Teasdale²,

Wang³

et al. 2014

Aids

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“…16 In contrast, a South African study found no age difference between ART initiators and refusers. 38 Delayed ART initiation is common in sub-Saharan Africa [39][40][41][42] and results from health system, provider, and patient-level factors. 41,[43][44][45][46] Individuals who delay ART initiation may not be motivated to achieve the high level of adherence needed to achieve and sustain viral suppression 47 or may have competing priorities, less stable lives, and less familiarity or experience with daily treatment.…”

Section: Discussionmentioning

confidence: 99%

Younger Age Predicts Failure to Achieve Viral Suppression and Virologic Rebound Among HIV-1-Infected Persons in Serodiscordant Partnerships

Mujugira

Celum

Tappero

et al. 2016

AIDS Research and Human Retroviruses

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Background: Antiretroviral therapy (ART) markedly reduces the risk of HIV-1 transmission in serodiscordant partnerships. We previously found that younger age and higher CD4 counts were associated with delayed initiation of ART by HIV-1-infected partners in serodiscordant partnerships. Among those initiating ART, we sought to explore whether those same factors were associated with failure to achieve viral suppression. Methods: In a prospective study of HIV-1-infected persons who had a known heterosexual HIV-1-uninfected partner in Kenya and Uganda [Partners Pre-Exposure Prophylaxis (PrEP) Study], we used Cox proportional hazards regression to evaluate correlates of viral nonsuppression (HIV-1 RNA >80 copies/ml). Results: Of 1,035 HIV-1-infected participants initiating ART, 867 (84%) achieved viral suppression: 77% by 6 months and 86% by 12 months. Younger age [adjusted hazard ratio (aHR) 1.05 for every 5 years younger; p = .006], lower pretreatment CD4 count (aHR 1.26; p = .009 for £250 compared with >250 cells/ll), and higher pretreatment HIV-1 RNA quantity (aHR 1.21 per log 10 ; p < .001) independently predicted failure to achieve viral suppression. Following initial viral suppression, 8.8% (76/867) experienced virologic rebound (HIV-1 RNA >200 copies/ml): 6.3% and 11.5% by 6 and 12 months after initial suppression, respectively. Age was the only factor associated with increased risk of virologic rebound (aHR 1.33 for every 5 years younger; p = .005). Conclusions: For HIV-1-infected persons in serodiscordant couples, younger age was associated with delayed ART initiation, failure to achieve viral suppression, and increased risk of virologic rebound. Motivating ART initiation and early adherence is a key to achieving and sustaining viral suppression.

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“…59-63 However, separate clinical sites for TB and HIV can result in reduced TB or HIV case finding and poor (62%) or delayed (32%) linkage to care, 64 as well as low rates of ART-initiation (13-62%). 64-67 …”

Section: Search Strategy and Selection Criteriamentioning

confidence: 99%

HIV, Tuberculosis, and Noncommunicable Diseases

Hyle

Naidoo

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Unprecedented investments in health systems low- and middle-income countries (LMICs) have resulted in more than eight million individuals on antiretroviral therapy (ART). Such individuals experience dramatically increased survival, but are increasingly at risk of developing common non-communicable diseases (NCDs). Integrating clinical care for HIV, other infectious diseases, and NCDs could make health services more effective and provide greater value. Cost-effectiveness analysis is a method to evaluate the clinical benefits and costs associated with different healthcare interventions and offers guidance for prioritization of investments and scale-up, especially as resources are increasingly constrained. We first examine tuberculosis and HIV as one example of integrated care already successfully implemented in several LMICs; we then review the published literature regarding cervical cancer and depression as two examples of NCDs for which integrating care with HIV services could offer excellent value. Direct evidence of the benefits of integrated services generally remains scarce; however, data suggest that improved effectiveness and reduced costs may be attained by integrating additional services with existing HIV clinical care. Further investigation into clinical outcomes and costs of care for NCDs among people living with HIV (PLHIV) in LMICs will help to prioritize specific healthcare services by contributing to an understanding of the affordability and implementation of an integrated approach.

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Retention and attrition during the preparation phase and after start of antiretroviral treatment in Thyolo, Malawi, and Kibera, Kenya: implications for programmes?

Cited by 44 publications

References 20 publications

Characteristics and outcomes of HIV-infected youth and young adolescents enrolled in HIV care in Kenya

Characteristics and outcomes of HIV-infected youth and young adolescents enrolled in HIV care in Kenya

Younger Age Predicts Failure to Achieve Viral Suppression and Virologic Rebound Among HIV-1-Infected Persons in Serodiscordant Partnerships

HIV, Tuberculosis, and Noncommunicable Diseases

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