Connecting-Africa | Find publications

Advanced search

Find:


Title Early loss to program in HIV-infected patients starting potent antiretroviral therapy in lower-income countries
Full text http://www.hal.inserm.fr/inserm-00182959/en/
Date 2008
Author(s) Brinkhof, Martin; Dabis, François; Myer, Landon; Bangsberg, David; Boulle, Andrew; Nash, Denis; Schechter, Mauro; Laurent, Christian; Keiser, Olivia; May, Margaret; Sprinz, Eduardo; Egger, Matthias; Anglaret, Xavier
Abstract Objective: The follow-up of patients starting antiretroviral therapy (ART) is important to monitor clinical outcomes and evaluate program effectiveness. We analysed early loss to follow-up in resource-limited settings. Methods: Using data on 5,491 adult patients starting ART with a combination ≥3 drugs in 15 treatment programs in Africa, Asia and Latin America and ≥12 months of potential follow-up, we investigated risk factors for no follow-up after the treatment initiation visit, loss to followup and death in the first 6 months after starting ART. Findings: The median age at ART initiation was 35 years, 46% of patients were women and the median CD4 cell count was 105 cells/μl. A total of 211 patients (3.8%) had no follow-up, 880 (16.0%) were lost to follow-up and 141 (2.6%) were known to have died in the first six months. The probability of no follow-up (odds ratio [OR] 5.06, 95% CI 1.28-20.0) and loss to follow-up in the first six months (hazard ratio [HR] 7.62, 4.55-12.8), but not of recorded death (HR 1.02, 0.44-2.36) was higher in years 2003-2004 compared to 2000 or earlier. Compared to baseline CD4 cell count ≥50 cells/μl, CD4 <25 cells/μl were associated with a higher probability of no follow-up (OR 2.49 [1.43-4.33]), loss to follow-up (HR 1.48 [1.23-1.77]) and death (HR 3.34 [2.10-5.30]). Compared to free treatment, fee for service programs were associated with no follow-up (OR 3.71 [0.97-16.05]) and higher mortality (HR 4.64 [1.11- 19.41]). Conclusion:Objective: The follow-up of patients starting antiretroviral therapy (ART) is important to monitor clinical outcomes and evaluate program effectiveness. We analysed early loss to follow-up in resource-limited settings. Methods: Using data on 5,491 adult patients starting ART with a combination ≥3 drugs in 15 treatment programs in Africa, Asia and Latin America and ≥12 months of potential follow-up, we investigated risk factors for no follow-up after the treatment initiation visit, loss to followup and death in the first 6 months after starting ART. Findings: The median age at ART initiation was 35 years, 46% of patients were women and the median CD4 cell count was 105 cells/μl. A total of 211 patients (3.8%) had no follow-up, 880 (16.0%) were lost to follow-up and 141 (2.6%) were known to have died in the first six months. The probability of no follow-up (odds ratio [OR] 5.06, 95% CI 1.28-20.0) and loss to follow-up in the first six months (hazard ratio [HR] 7.62, 4.55-12.8), but not of recorded death (HR 1.02, 0.44-2.36) was higher in years 2003-2004 compared to 2000 or earlier. Compared to baseline CD4 cell count ≥50 cells/μl, CD4 <25 cells/μl were associated with a higher probability of no follow-up (OR 2.49 [1.43-4.33]), loss to follow-up (HR 1.48 [1.23-1.77]) and death (HR 3.34 [2.10-5.30]). Compared to free treatment, fee for service programs were associated with no follow-up (OR 3.71 [0.97-16.05]) and higher mortality (HR 4.64 [1.11- 19.41]). Conclusion: Early losses to ART programs are increasingly common in the context of scaling-up and associated with fee for service programs and more advanced immunodeficiency at baseline. Measures to maximize program retention are required in resource-poor countries. Early losses to ART programs are increasingly common in the context of scaling-up and associated with fee for service programs and more advanced immunodeficiency at baseline. Measures to maximize program retention are required in resource-poor countries.
Subject(s) Life Sciences/Santé publique et épidémiologie
Language EN
Publisher HAL - CCSD
Relation http://hal.archives-ouvertes.fr/docs/00/18/29/59/PDF/ART_Bull_WHO.pdf
Type of publication peer-reviewed article
Identifier HAL:inserm-00182959, version 1; DOI:10.2471/07.044248
Repository France - Hyper Article en Ligne (HAL)
Added to C-A: 2008-12-22;03:41:45