Trends in Retention on Antiretroviral Therapy in National Programs in Low-Income and Middle-Income Countries

Abstract

After high attrition in the first year, retention on ART tends to stabilize. In the literature, attrition in the first year was related to early mortality. Earlier presentation for diagnosis of HIV infection, timely screening, and access to ART are fundamental to reduce it. Countries need support in reporting on outcomes on ART.

Resistance to Antiretroviral Drugs in Treated and Drug-Naive Patients in the Democratic Republic of Congo

“…Median time on ART was 25 months [interquartile ratio (IQR), 19-32] in Kinshasa, 26 months (IQR, 19-32) in Matadi, 27 months (IQR, 19-44) in Lubumbashi, and 19 months (IQR,(16)(17)(18)(19)(20)(21)(22)(23)(24) in Mbuji-Mayi. A total of 97 patients (14.6%) had viral load .1000 copies/mL, and among the 93 successfully sequenced samples, 78 (83.9%) were resistant to at least 1 drug of their ART regimen: 68 harbored resistance mutations to nucleoside reverse transcriptase inhibitor (NRTI) and nonnucleoside reverse transcriptase inhibitor (NNRTI), 2 to NRTI only, 7 to NNRTI only, and 1 to NRTI + NNRTI + protease inhibitor.…”

“…However, it is known that rates of lost to follow-up are the highest in the first year and retention on ART tends to decline thereafter. 16 Our estimates of drug resistance in treated patients in DRC are thus most likely minimal estimates. Another limitation of our study is that among the different NGOs and public hospitals that are involved in ART care, we studied only patients who attended the ART care sites developed by the NGO AMO-Congo, which was the main Congolese NGO specialized in HIV/AIDS work.…”

“…Switch concerned mainly replacement of d4T by AZT or NVP by EFV and only 7 switched to protease inhibitor (PI) regimens. Overall, the median time on ART was 25 months (IQR, 19-32) in Kinshasa, 26 (IQR, [19][20][21][22][23][24][25][26][27][28][29][30][31][32] in Matadi, 27 (IQR, in Lubumbashi, and 19 [13][14][15][16][17][18][19][20][21] in Mbuji-Mayi (IQR, [16][17][18][19][20][21][22][23][24].…”

Long-term immunological outcomes in treated HIV-infected individuals in high-income and low-middle income countries

“…A recent analysis on South African cohorts suggested that although trends in early (at 12 months) mortality have declined over time from 2002-2007, the rate of loss to follow-up has increased [59,69]. Loss to follow-up at 6-12 months is around 25% in several African cohorts [70][71][72][73][74]. Further, the loss to follow-up is highest in those with lower baseline CD4 þ cell counts who are at greater risk of death [53 ,64,75-77].…”

Factors contributing to dropping out from and returning to HIV treatment in an inner city primary care HIV clinic in the United States

“…Modern pharmacotherapies (e.g., highly active antiretroviral therapy [HAART]), have made it possible for HIV' people to live longer and with better quality of life (Detels et al, 2001), however, patients who leave treatment lose access to HIV medications, and this is problematic in many countries (e.g., Tassie et al, 2010). This study aimed to explore reasons given by patients for leaving and returning to treatment; findings could guide the development of interventions to help patients stay in care.…”