When are patients lost to follow-up in pre-antiretroviral therapy care? a retrospective assessment of patients in an Ethiopian rural hospital

Shaweno, Tamrat; Shaweno, Debebe

doi:10.1186/s40249-015-0056-y

Cited by 9 publications

(10 citation statements)

References 25 publications

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“…In Myanmar, within the IHC programme, an alarmingly high attrition rate was observed with nearly 70% being either dead or LTFU at the end of 4 years. This is one of the highest rates of attrition ever reported, in line with published reports from Asia and Africa ( 6 – 8 , 15 – 21 ). Most of the attrition occurred in the early stages of enrolment into care: 90% of attrition occurred within first 6 months with nearly half in the first month.…”

Section: Discussionsupporting

confidence: 88%

Alarming attrition rates among HIV-infected individuals in pre-antiretroviral therapy care in Myanmar, 2011–2014

Gupta

Aung

et al. 2016

Global Health Action

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BackgroundHigh retention rates have been documented among patients receiving antiretroviral therapy (ART) in Myanmar. However, there is no information on human immunodeficiency virus (HIV)-infected individuals in care before initiation of ART (pre-ART care). We assessed attrition (loss-to-follow-up [LTFU] and death) rates among HIV-infected individuals in pre-ART care and their associated factors over a 4-year period.DesignIn this retrospective cohort study, we extracted routinely collected data of HIV-infected adults (>15 years old) entering pre-ART care (June 2011–June 2014) as part of an Integrated HIV Care (IHC) programme, Myanmar. Attrition rates per 100 person-years and cumulative incidence of attrition were calculated. Factors associated with attrition were examined by calculating hazard ratios (HRs).ResultsOf 18,037 HIV-infected adults enrolled in the IHC programme, 11,464 (63%) entered pre-ART care (60% men, mean age 37 years, median cluster of differentiation 4 (CD4) cell count 160 cells/µL). Of the 11,464 eligible participants, 3,712 (32%) underwent attrition of which 43% were due to deaths and 57% were due to LTFU. The attrition rate was 78 per 100 person-years (95% CI, 75–80). The cumulative incidence of attrition was 70% at the end of a 4-year follow-up, of which nearly 90% occurred in the first 6 months. Male sex (HR 1.5, 95% CI 1.4–1.6), WHO clinical Stage 3 and 4, CD4 count <200 cells/µL, abnormal BMI, and anaemia were statistically significant predictors of attrition.ConclusionsPre-ART care attrition among persons living with HIV in Myanmar was alarmingly high – with most attrition occurring within the first 6 months. Strategies aimed at improving early HIV diagnosis and initiation of ART are needed. Suggestions include comprehensive nutrition support and intensified monitoring to prevent pre-ART care attrition by tracking patients who do not return for pre-ART care appointments. It is high time that Myanmar moves towards a ‘test and treat’ approach and ultimately eliminates the need for pre-ART care.

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Section: Discussionsupporting

confidence: 88%

Alarming attrition rates among HIV-infected individuals in pre-antiretroviral therapy care in Myanmar, 2011–2014

Gupta

Aung

et al. 2016

Global Health Action

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“…These included TB [39,[44][45][46] and diarrhea for more than 3 months led a risk of death [18]. Nine papers reported that provision of isoniazid preventive therapy (IPT) [17,18,35,38,39,50,54] and CPT [25,29] prophylaxis indicted that optimize patient retention.…”

Section: Clinical Related Factorsmentioning

confidence: 99%

HIV patients retention and attrition in care and their determinants in Ethiopia: a systematic review and meta-analysis

et al. 2020

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Background: There is paucity of evidence on the magnitude of HIV patients' retention and attrition in Ethiopia. Hence, the aim of this study was to determine the pooled magnitude of HIV patient clinical retention and attrition and to identify factors associated with retention and attrition in Ethiopia. Methods: Systematic review and meta-analysis were done among studies conducted in Ethiopia using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Both published and unpublished studies conducted from January 1, 2005 to June 6th, 2019 were included. Major databases and search engines such as Google Scholar, PUBMED, African Journals Online (AJOL) and unpublished sources were searched to retrieve relevant articles. Data were assessed for quality, heterogeneity and publication bias. Analysis was conducted using STATA version 14 software. Result: From a total of 45 studies 546,250 study participants were included in this review. The pooled magnitude of retention in care among HIV patients was 70.65% (95% CI, 68.19, 73.11). The overall magnitude of loss to follow up 15.17% (95% CI, 11.86, 18.47), transfer out 11.17% (95% CI, 7.12, 15.21) and death rate were 6.75% (95% CI, 6.22, 7.27). Major determinants of attrition were being unmarried patient (OR 1.52, 95% CI: 1.15-2.01), non-disclosed HIV status (OR 6.36, 95% CI: 3.58-11.29), poor drug adherence (OR 6.60, 95% CI: 1.41-30.97), poor functional status (OR 2.11, 95% CI: 1.33-3.34), being underweight (OR 2.21, 95% CI: 1.45-3.39) and advanced clinical stage (OR 1.85, 95% CI: 1.36-2.51). Whereas absence of opportunistic infections (OR 0.52, 95% CI: 0.30-0.9), normal hemoglobin status (OR 0.29, 95% CI: 0.20-0.42) and non-substance use (OR 95% CI: 0.41, 0.17-0.98) were facilitators of HIV patient retention in clinical care. Conclusion: The level of retention to the care among HIV patients was low in Ethiopia. Socioeconomic , clinical, nutritional and behavioral, intervention is necessary to achieve adequate patient retention in clinical care.

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“…Among structural factors, barriers to health care delivery, such as distance to a health care facility, have been commonly reported [8,15, 16].Psychosocial circumstances, including the presence of social support and an ability to disclose one's HIV status, have been found to affect linkage to care and ART initiation [17, 18]. In addition, behavioural patterns related to perceptions of the health bene ts of early ART [19][20][21][22], as well as an acceptance of HIV positive status, have been strongly linked to the level of the patients' engagement in care and ART initiation [10,19,23]. Sociodemographic characteristics, such as patient age and gender, have also been frequently reported to be associated with late linkage to care and delays in ART initiation [17,20,[24][25][26][27].Across published studies, there are variations in de nitions of HIV care-related health outcomes as well as contextual differences associated with the risk factors for late linkage to care and delayed ART initiation.…”

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confidence: 99%

Risk Factors for Late Linkage to Care and Delayed Antiretroviral Therapy Initiation Amongst HIV Infected Adults in Sub-saharan Africa: a Systematic Review and Meta-analyses

Fuge

Tsourtos

Miller

2022

Preprint

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Background: Late linkage to care and delay in antiretroviral therapy (ART) initiation threaten the clinical and public health benefits of ART such as: preventing acquired immunodeficiency syndrome (AIDS) and non-AIDS related morbidities and mortality, as well as reducing new infections. The prevalence of both of these poor care outcomes remains high in sub-Saharan African (SSA) countries. Quantitative synthesises of the existing data are lacking, which would help ascertain the best evidence-based interventions. This review aimed to systematically synthesise the available literature on factors affecting linkage to care and ART initiation amongst HIV infected adults in SSA. Methods: Systematic searches were undertaken of the following databases: Emcare, Medline, PubMed and Web of Science. In our review, we included observational studies that analysed factors affecting linkage to HIV care and ART initiation amongst adults (age ≥19 years) in SSA, and were published between January 1, 2015 and June 1, 2021. All included studies were assessed for risk of bias using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. RevMan-5 software was used to conduct meta-analyses and Mantel-Haenszel statistics to pool outcomes with 95% confidence interval and <0.05 level of significance. The review protocol has been published at the International Prospective Register of Systematic Reviews (PROSPERO; Number: CRD42021264398).Results: Forty-six studies were included in the systematic review, of which 18 fulfilled requirements for meta-analysis. Health care delivery, psychosocial, behavioural and sociodemographic factors were identified as determinants of late linkage to care and delay in ART initiation. The meta-analyses showed that people of a younger age group (<35 years) were 29% (OR: 0.71; 95%CI: 0.55-0.91, I2 = 74%) and 45% (OR: 0.55; 95%CI: 0.49-0.63, I2 = 0%) less likely to be linked to care and initiate ART respectively compared to people of an older age group (≥35 years). Employed people and people who travelled for more than an hour to reach a clinic were more than 1.3 (OR: 1.32; 95%CI: 1.14-1.52, I2 = 14%) and 1.2 (OR: 1.27; 95%CI: 1.15-1.39, I2 = 57%) times more likely to be presented late for care, respectively. The likelihood of linkage to care decreased by 26% (OR: 0.74; 95%CI: 0.62-0.87, I2 = 25%) for people who were unable to disclose their HIV status and 50% (OR: 0.50; 95%CI: 0.42-0.60, I2 = 0%) for those who had a baseline CD4 count >350cells/mm3 compared to CD4 count ≤350cells/mm3, but increased by 65% (OR: 1.65; 95%CI: 1.16-2.34, I2 = 0%) for those who were diagnosed through health facility-based testing approaches compared to community-based approaches. Conclusion: This systematic review and meta-analyses identified a range of risk factors for late linkage to care and delayed ART initiation amongst HIV infected adults in SSA including: health service delivery, psychosocial, behavioural and sociodemographic circumstances. We recommend implementation of patient-centred intervention approaches to alleviate these barriers.

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When are patients lost to follow-up in pre-antiretroviral therapy care? a retrospective assessment of patients in an Ethiopian rural hospital

Cited by 9 publications

References 25 publications

Alarming attrition rates among HIV-infected individuals in pre-antiretroviral therapy care in Myanmar, 2011–2014

Alarming attrition rates among HIV-infected individuals in pre-antiretroviral therapy care in Myanmar, 2011–2014

HIV patients retention and attrition in care and their determinants in Ethiopia: a systematic review and meta-analysis

Risk Factors for Late Linkage to Care and Delayed Antiretroviral Therapy Initiation Amongst HIV Infected Adults in Sub-saharan Africa: a Systematic Review and Meta-analyses

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