Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study


Autoři: Catrina Mugglin aff001;  Andreas D. Haas aff001;  Joep J. van Oosterhout aff002;  Malango Msukwa aff004;  Lyson Tenthani aff001;  Janne Estill aff001;  Matthias Egger aff001;  Olivia Keiser aff001
Působiště autorů: Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland aff001;  Dignitas International, Zomba, Malawi aff002;  Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi aff003;  Baobab Health Trust, Lilongwe, Malawi aff004;  Institute of Global Health, University of Geneva, Geneva, Switzerland aff005;  I-TECH Malawi, Lilongwe, Malawi aff006
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224837

Souhrn

Objectives

We examine long-term retention of adults, adolescents and children on antiretroviral therapy under different HIV treatment guidelines in Malawi.

Design

Prospective cohort study.

Setting and participants

Adults and children starting ART between 2005 and 2015 in 21 health facilities in southern Malawi.

Methods

We used survival analysis to assess retention at clinic level, Cox regression to examine risk factors for loss to follow up, and competing risk analysis to assess long-term outcomes of people on antiretroviral therapy (ART).

Results

We included 132,274 individuals in our analysis, totalling 270,256 person years of follow up (PYFU; median per patient 1.3, interquartile range (IQR) 0.26–3.1), 62% were female and the median age was 32 years. Retention on ART was lower in the first year on ART compared to subsequent years for all guideline periods and age groups. Infants (0–3 years), adolescents and young adults (15–24 years) were at highest risk of LTFU. Comparing the different calendar periods of ART initiation we found that retention improved initially, but remained stable thereafter.

Conclusion

Even though the number of patients and the burden on health care system increased substantially during the study period of rapid ART expansion, retention on ART improved in the early years of ART provision, but gains in retention were not maintained over 5 years on ART. Reducing high attrition in the first year of ART should remain a priority for ART programs, and so should addressing poor retention among adolescents, young adults and men.

Klíčová slova:

Adolescents – Age groups – Electronic medical records – HIV epidemiology – Malawi – Young adults


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2019 Číslo 11