Incidence and predictors of loss to follow up among adult HIV patients on antiretroviral therapy in University of Gondar Comprehensive Specialized Hospital: A competing risk regression modeling


Autoři: Achamyeleh Birhanu Teshale aff001;  Adino Tesfahun Tsegaye aff001;  Haileab Fekadu Wolde aff001
Působiště autorů: Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia aff001
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227473

Souhrn

Introduction

Loss to follow up after the initiation of antiretroviral therapy (ART) is common in Africa, particularly in Ethiopia and it is a considerable obstacle for the effectiveness of the ART program. Mortality is a competing risk of loss to follow up but it is often overlooked and there is limited evidence about the incidence and predictors of loss to follow up in the presence of competing events.

Objective

To assess the Incidence and predictors of loss to follow up among adult HIV patients on ART in University of Gondar Comprehensive Specialized Hospital between January 1, 2015, and December 31, 2018.

Methods

Institution based retrospective follow up study was conducted in University of Gondar Comprehensive Specialized Hospital. A Gray’s test and cumulative incidence curve were used to compare the cumulative incidence function of loss to follow up. Bivariable and multivariable competing risk regression models were fitted to identify the predictors of lost to follow up and those variables with p-value <0.05 in the multivariable analysis was considered as significant predictors of lost to follow up.

Result

A total of 531 adult HIV patients on ART were included in the analysis. The incidence rate of loss to follow up in this study was 10.90 (95% CI: 8.9–13.2) per 100 person years. Being age group 15–30 years (aSHR = 2.01; 95%CI;1.11–3.63), being daily laborer(aSHR = 2.60; 95%CI;1.45–4.66), not receiving cotrimoxazole preventive therapy (aSHR = 2.66; 95%CI;1.68–4.21), not receiving isoniazid preventive therapy(aSHR = 4.57; 95% CI;1.60–13.08), ambulatory functional status (aSHR = 1.61; 95% CI; 1.02–2.51) and taking AZT-3TC-NVP medication at start of ART(aSHR = 2.01; 95% CI; 1.16–3.78) were significant predictors of lost to follow up.

Conclusion

In this study the incidence of lost to follow up was high. Young people, daily laborer, ambulatory patients and those taking AZT-3TC-NVP as well as those who did not take opportunistic prophylaxis were at higher risk of loss to follow up. Therefore, giving special attention to the high-risk groups for lost to follow up highlighted in this study could decrease the rate of LTFU.

Klíčová slova:

Antiretroviral therapy – Data processing – Ethiopia – HIV – HIV infections – Opportunistic infections – Professions – Walking


Zdroje

1. WHO. WHO | Antiretroviral therapy (ART) coverage among all age groups. Global health Observatory (GHO). 2018.

2. UNAIDS. HIV and AIDS in East and Southern Africa regional overview. Avert. 2018.

3. PEPFAR. Differentiated Care in Ethiopia The way forward. 2017.

4. May MT, Gompels M, Delpech V, Porter K, Orkin C, Kegg S, et al. Impact on life expectancy of HIV-1 positive individuals of CD4R cell count and viral load response to antiretroviral therapy. Aids. 2014;28(8):1193–202. 24556869

5. May M, Gompels M, Delpech V, Porter K, Post F, Johnson M, et al. Impact of late diagnosis and treatment on life expectancy in people with HIV-1: UK Collaborative HIV Cohort (UK CHIC) Study. BMJ. 2011;343(7829):1–11.

6. Brinkhof MWG, Pujades-Rodriguez M, Egger M. Mortality of patients lost to follow-up in antiretroviral treatment programmes in resource-limited settings: Systematic review and meta-analysis. PLoS One. 2009;4(6).

7. Brinkhof MWG, Dabis F, Myer L, Bangsberg DR, Boulle A, Nash D, et al. Early loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countries. Bull World Health Organ. 2008;86(7):559–67. 18670668

8. Bartlett JA, Shao JF. Successes, challenges, and limitations of current antiretroviral therapy in low-income and middle-income countries. Lancet Infect Dis. 2009;9(10):637–49. doi: 10.1016/S1473-3099(09)70227-0 19778766

9. Fox MP, Rosen S. Patient retention in antiretroviral therapy programs up to three years on treatment in sub-Saharan Africa, 2007–2009: Systematic review. Trop Med Int Heal. 2010;15(SUPPL. 1):1–15.

10. Asiimwe SB, Kanyesigye M, Bwana B, Okello S, Muyindike W. Predictors of dropout from care among HIV-infected patients initiating antiretroviral therapy at a public sector HIV treatment clinic in sub-Saharan Africa. BMC Infect Dis. 2016;16(1):1–10.

11. Assemie MA, Muchie KF, Ayele TA. Incidence and predictors of loss to follow up among HIV-infected adults at Pawi General Hospital, northwest Ethiopia: Competing risk regression model. BMC Res Notes. 2018;11(1):1–6.

12. Fisaha Haile KT. Predictors of Loss to Follow Up of Patients Enrolled on Antiretroviral Therapy: A Retrospective Cohort Study. J AIDS Clin Res. 2014;5(12).

13. Berheto TM, Haile DB, Mohammed S. Predictors of loss to follow-up in patients living with hiv/aids after initiation of antiretroviral therapy. N Am J Med Sci. 2014;6(9):453–9. doi: 10.4103/1947-2714.141636 25317390

14. Mehari D, Mache T, Hailemariam L. Predictors of lost to follow up to antiretroviral therapy in primary public hospital of Wukro, Tigray, Ethiopia: A case control study. J AIDS HIV Res. 2015;7(1):1–9.

15. Ayele W, Mulugeta A, Desta A, Rabito FA. Treatment outcomes and their determinants in HIV patients on Anti-retroviral Treatment Program in selected health facilities of Kembata and Hadiya zones, Southern Nations, Nationalities and Peoples Region, Ethiopia. BMC Public Health [Internet]. 2015;15(1):1–13. Available from: http://dx.doi.org/10.1186/s12889-015-2176-5

16. Seifu W, Ali W, Meresa B. Predictors of loss to follow up among adult clients attending antiretroviral treatment at Karamara general hospital, Jigjiga town, Eastern Ethiopia, 2015: A retrospective cohort study. BMC Infect Dis. 2018;18(1):1–8.

17. Abbas UL A R and M J. Erratum: Potential impact of antiretroviral therapy on HIV-1 transmission and AIDS mortality in resource-limited settings (Journal of Acquired Immune Deficiency Syndromes 41, 5 (632–641)). J Acquir Immune Defic Syndr. 2006;42(2):262.

18. Oyugi JH, Byakika-Tusiime J, Ragland K, Laeyendecker O, Mugerwa R, Kityo C, et al. Treatment interruptions predict resistance in HIV-positive individuals purchasing fixed-dose combination antiretroviral therapy in Kampala, Uganda. Aids. 2007;21(8):965–71. 17457090

19. Schaecher KL. The importance of treatment adherence in HIV. Vol. 19, American Journal of Managed Care. 2013. p. S231–7.

20. Wang H, Fennie K, Williams AB. with Improved Quality of Life, CD4 Counts. AIDS Res Hum Retroviruses. 2009;25(8).

21. Mberi MN, Kuonza LR, Dube NM, Nattey C, Manda S, Summers R. Determinants of loss to follow-up in patients on antiretroviral treatment, South Africa, 2004–2012: A cohort study. BMC Health Serv Res. 2015;15(1):1–11.

22. Onoka CA, Uzochukwu BS, Onwujekwe OE, Chukwuka C, Ilozumba J, Onyedum C, et al. Retention and loss to follow-up in antiretroviral treatment programmes in southeast Nigeria. Pathog Glob Health. 2012;106(1):46–54. doi: 10.1179/2047773211Y.0000000018 22595274

23. Haile Fisaha T K. Predictors of Loss to Follow Up of Patients Enrolled on Antiretroviral Therapy: A Retrospective Cohort Study. J AIDS Clin Res. 2015;5(12).

24. Webb S, Hartland J. A retrospective notes-based review of patients lost to follow-up from anti-retroviral therapy at Mulanje mission hospital, Malawi. Malawi Med J. 2018;30(2):73–8. doi: 10.4314/mmj.v30i2.4 30627332

25. Meloni ST, Chang C, Chaplin B, Rawizza H, Jolayemi O, Banigbe B, et al. Time-Dependent Predictors of Loss to Follow-Up in a Large HIV Treatment Cohort in Nigeria. 2012;

26. Hønge BL, Jespersen S, Nordentoft PB, Medina C, Da Silva D, Da Silva ZJ, et al. Loss to follow-up occurs at all stages in the diagnostic and follow-up period among HIV-infected patients in Guinea-Bissau: A 7-year retrospective cohort study. BMJ Open. 2013;3(10):1–10.

27. Akilimali PZ, Musumari PM, Kashala-Abotnes E, Kayembe PK, Lepira FB, Mutombo PB, et al. Disclosure of HIV status and its impact on the loss in the follow-up of HIV-infected patients on potent anti-retroviral therapy programs in a (post-) conflict setting: A retrospective cohort study from goma, Democratic Republic of Congo. PLoS One. 2017;12(2):1–13.

28. Alvarez-Uria G, Naik PK, Pakam R, Midde M. Factors associated with attrition, mortality, and loss to follow up after antiretroviral therapy initiation: data from an HIV cohort study in India. Glob Health Action [Internet]. 2013;6:21682. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24028937%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC3773168 24028937

29. Bekolo CE, Webster J, Batenganya M, Sume GE, Kollo B. Trends in mortality and loss to follow-up in HIV care at the Nkongsamba Regional hospital, Cameroon. BMC Res Notes. 2013;6(1):1–16.

30. Mberi MN, Kuonza LR, Dube NM, Nattey C, Manda S, Summers R. Determinants of loss to follow-up in patients on antiretroviral treatment, South Africa, 2004–2012: A cohort study. BMC Health Serv Res [Internet]. 2015;15(1):1–11. Available from: http://dx.doi.org/10.1186/s12913-015-0912-2

31. Megerso A, Garoma S, Eticha T, Workineh T, Daba S, Tarekegn M, et al. Predictors of loss to follow-up in antiretroviral treatment for adult patients in the Oromia region, Ethiopia. HIV/AIDS—Res Palliat Care. 2016;8:83–92.

32. Tiruneh YM, Galárraga O, Genberg B, Wilson IB. Retention in care among HIV-infected adults in Ethiopia, 2005–2011: A mixed-methods study. PLoS One. 2016;11(6):2005–11.

33. Eshun-Wilson I, Rohwer A, Hendricks L, Oliver S, Garner P. Being HIV positive and staying on antiretroviral therapy in Africa: A qualitative systematic review and theoretical model. PLoS One. 2019;14(1):1–30.

34. Agaba PA, Meloni ST, Sule HM, Agbaji OO, Sagay AS, Okonkwo P, et al. Treatment Outcomes Among Older Human Immunodeficiency Virus-Infected Adults in Nigeria. 2012;1–9.

35. Wubshet M, Berhane Y, Worku A, Kebede Y, Diro E. High Loss to Followup and Early Mortality Create Substantial Reduction in Patient Retention at Antiretroviral Treatment Program in North-West Ethiopia. Isrn Aids. 2012;2012:1–9.

36. Odafe S, Idoko O, Badru T, Aiyenigba B, Suzuki C, Khamofu H, et al. Patients ‘ demographic and clinical characteristics and level of care associated with lost to follow-up and mortality in adult patients on first-line ART in Nigerian hospitals. 2012;1–9.

37. Mekonnen N, Abdulkadir M, Shumetie E, Baraki AG, Yenit MK. Incidence and predictors of loss to follow-up among HIV infected adults after initiation of first line anti-retroviral therapy at University of Gondar comprehensive specialized Hospital Northwest Ethiopia, 2018: Retrospective follow up study. BMC Res Notes [Internet]. 2019;12(1):1–7. Available from: https://doi.org/10.1186/s13104-019-4154-y

38. Manual P. National Comprehensive HIV Prevention, Care and Treatment Training for Health care Providers. 2018;

39. Zhou J, Tanuma J, Chaiwarith R, Lee CKC, Law MG, Kumarasamy N, et al. Loss to followup in HIV-infected patients from Asia-pacific region: Results from TAHOD. AIDS Res Treat. 2012;2012.

40. Huo Y, Aboud K, Kang H, Cutting LE, Bennett A. Loss to follow-up trends in HIV-positive patients receiving antiretroviral treatment in Asia from 2003 to 2013. 2017;44(9):1–13.

41. Wilkinson LS, Skordis-Worrall J, Ajose O, Ford N. Self-transfer and mortality amongst adults lost to follow-up in ART programmes in low- and middle-income countries: Systematic review and meta-analysis. Trop Med Int Heal. 2015;20(3):365–79.

42. Mukamba N, Chilyabanyama ON, Beres LK, Simbeza S, Sikombe K, Padian N, et al. Patients’ Satisfaction with HIV Care Providers in Public Health Facilities in Lusaka: A Study of Patients who were Lost-to-Follow-Up from HIV Care and Treatment. AIDS Behav [Internet]. 2019;(0123456789). Available from: https://doi.org/10.1007/s10461-019-02712-4

43. Marson KG, Tapia K, Kohler P, McGrath CJ, John-Stewart GC, Richardson BA, et al. Male, Mobile, and Moneyed: Loss to Follow-Up vs. Transfer of Care in an Urban African Antiretroviral Treatment Clinic. PLoS One. 2013;8(10):2–9.

44. Deribe K, Hailekiros F, Biadgilign S, Amberbir A, Beyene BK. Defaulters from antiretroviral treatment in Jimma University Specialized Hospital, Southwest Ethiopia. Trop Med Int Heal. 2008;13(3):328–33.

45. Cohen CJ, Meyers JL, Davis KL. Association between daily antiretroviral pill burden and treatment adherence, hospitalisation risk, and other healthcare utilisation and costs in a US Medicaid population with HIV. BMJ Open. 2013;3(8):1–12.

46. Parkes-Ratanshi R, Katende D, Levin J, Wakeham K, Heiner G, Kamali A, et al. Development of Severe Anemia and Changes in Hemoglobin in a Cohort of HIV-Infected Ugandan Adults Receiving Zidovudine-, Stavudine-, and Tenofovir-Containing Antiretroviral Regimens. J Int Assoc Provid AIDS Care. 2015;14(5):455–62. doi: 10.1177/2325957414557264 25425638

47. Etenyi JO, Okalebo FA, Oluka M, Sinei KA, Osanjo GO, Kurdi A, et al. Comparison of zidovudine and tenofovir based regimens with regard to health-related quality of life and prevalence of symptoms in HIV patients in a Kenyan referral hospital. Front Pharmacol. 2018;9(OCT):1–14.

48. Insaniputri P, Supardi S, Andrajati R. Comparison of zidovudine combination and tenofovir combination on the effectiveness of therapy and side effects in HIV/AIDS patients in rsal mintohardjo. Asian J Pharm Clin Res. 2017;10(Special Issue October):93–6.

49. Dadi TL, Kefale AT, Mega TA, Kedir MS, Addo HA, Biru TT. Efficacy and Tolerability of Tenofovir Disoproxil Fumarate Based Regimen as Compared to Zidovudine Based Regimens: A Systematic Review and Meta-Analysis. AIDS Res Treat. 2017;2017.

50. Awino MS. Prevalence and Management of Opportunistic Infections in HIV-Infected Children. UoN [Internet]. 2014;(September). erepository.uonbi.ac.ke/%0Aerepository.uonbi.ac.ke/…/Mutua_Prevalence and Management of Oppor


Článek vyšel v časopise

PLOS One


2020 Číslo 1