Mortality Rate in a Cohort of People Living With HIV in Rural Tanzania After Accounting for Unseen Deaths Among Those Lost to Follow-up

Abstract Mortality assessment in cohorts with high numbers of persons lost to follow-up (LTFU) is challenging in settings with limited civil registration systems. We aimed to assess mortality in a clinical cohort (the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO)) of human immunodeficiency virus (HIV)-infected persons in rural Tanzania, accounting for unseen deaths among participants LTFU. We included adults enrolled in 2005–2015 and traced a nonrandom sample of those LTFU. We estimated mortality using Kaplan-Meier methods 1) with routinely captured data (method A), 2) crudely incorporating tracing data (method B), 3) weighting using tracing data to crudely correct for unobserved deaths among participants LTFU (method C), and 4) weighting using tracing data accounting for participant characteristics (method D). We investigated associated factors using proportional hazards models. Among 7,460 adults, 646 (9%) died, 883 (12%) transferred to other clinics, and 2,911 (39%) were LTFU. Of 2,010 (69%) traced participants, 325 (16%) were found: 131 (40%) had died and 130 (40%) had transferred. Five-year mortality estimates derived using the 4 methods were 13.1% (A), 16.2% (B), 36.8% (C), and 35.1% (D), respectively. Higher mortality was associated with male sex, referral as a hospital inpatient, living close to the index clinic, lower body mass index, more advanced World Health Organization HIV clinical stage, lower CD4 cell count, and less time since initiation of antiretroviral therapy. Adjusting for unseen deaths among participants LTFU approximately doubled the 5-year mortality estimates. Our approach is applicable to other cohort studies adopting targeted tracing.

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Retention in Care among Patients with Early HIV Disease in Haiti

Journal of the International Association of Providers of AIDS Care (JIAPAC) ◽

10.1177/2325957417742670 ◽

2017 ◽

Vol 16 (6) ◽

pp. 523-526 ◽

Cited By ~ 3

Author(s):

Kelly A. Hennessey ◽

Taina Dadaille Leger ◽

Vanessa R. Rivera ◽

Adias Marcelin ◽

Margaret L. McNairy ◽

...

Keyword(s):

Cell Count ◽

Retention In Care ◽

Hiv Treatment ◽

World Health ◽

People Living With Hiv ◽

Cd4 Cell Count ◽

Hiv Test ◽

Lost To Follow Up ◽

Cd4 Cell

In September 2015, the World Health Organization updated their guidelines to recommend antiretroviral therapy (ART) for all people living with HIV. Countries are now in the process of implementing strategies to provide universal HIV treatment. We analyzed the rate of retention and time to ART eligibility (according to 2013 WHO guidelines) among 3,345 adult patients receiving positive HIV test results between February 1, 2003 and March 31, 2013 at the GHESKIO Clinic in Haiti, with WHO stage 1 or 2 disease and initial CD4 cell count >500 cells/mm3. Among the 3,345 patients, 2,423 (72%) were female, the median age was 33 years, 3,089 (92%) lived in Port-au-Prince, and 1,944 (58%) had attended no school or primary school only. The median initial CD4 cell count was 668 cells/mm3 (IQR: 572-834); over the subsequent 2 years, 1,485 patients (44%) were lost to follow-up and 7 (<1%) died pre-ART, 1,041 (31%) were retained in pre-ART care, and 819 (24%) initiated ART. In multivariate analysis, secondary education (aOR 1.27; 95% CI: 1.10-1.47), female gender (aOR: 1.28; 95% CI: 1.09-1.50), co-habitation (aOR: 1.31; 95% CI: 1.09-1.57), and residence in Port-au-Prince (aOR: 1.43; 95% CI: 1.09-1.88) were associated with retention in care. The median time from baseline CD4 count to ART eligibility was 1.7 years. Prior to the implementation of universal treatment, pre-ART attrition was high among patients who did not qualify for ART at presentation. Though implementing WHO recommendations for universal ART will require service expansion, it will likely result in improved retention for those at risk of being lost to follow-up.

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Prevalence and Evolution of Renal Impairment in People Living With HIV in Rural Tanzania

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy072 ◽

2018 ◽

Vol 5 (4) ◽

Cited By ~ 1

Author(s):

Herry Mapesi ◽

Aneth V Kalinjuma ◽

Alphonce Ngerecha ◽

Fabian Franzeck ◽

Christoph Hatz ◽

...

Keyword(s):

Logistic Regression ◽

Renal Impairment ◽

Older Age ◽

Cd4 Count ◽

Noncommunicable Disease ◽

World Health ◽

People Living With Hiv ◽

Rural Tanzania ◽

Living With Hiv

Abstract Background We assessed the prevalence, incidence, and predictors of renal impairment among people living with HIV (PLWHIV) in rural Tanzania. Methods In a cohort of PLWHIV aged ≥15 years enrolled from January 2013 to June 2016, we assessed the association between renal impairment (estimated glomerural filtration rate < 90 mL/min/1.73 m2) at enrollment and during follow-up with demographic and clinical characteristcis using logistic regression and Cox proportional hazards models. Results Of 1093 PLWHIV, 172 (15.7%) had renal impairment at enrollment. Of 921 patients with normal renal function at baseline, 117 (12.7%) developed renal impairment during a median follow-up (interquartile range) of 6.2 (0.4–14.7) months. The incidence of renal impairment was 110 cases per 1000 person-years (95% confidence interval [CI], 92–132). At enrollment, logistic regression identified older age (adjusted odds ratio [aOR], 1.79; 95% CI, 1.52–2.11), hypertension (aOR, 1.84; 95% CI, 1.08–3.15), CD4 count <200 cells/mm3 (aOR, 1.80; 95% CI, 1.23–2.65), and World Health Organization (WHO) stage III/IV (aOR, 3.00; 95% CI, 1.96–4.58) as risk factors for renal impairment. Cox regression model confirmed older age (adjusted hazard ratio [aHR], 1.85; 95% CI, 1.56–2.20) and CD4 count <200 cells/mm3 (aHR, 2.05; 95% CI, 1.36–3.09) to be associated with the development of renal impairment. Conclusions Our study found a low prevalence of renal impairment among PLWHIV despite high usage of tenofovir and its association with age, hypertension, low CD4 count, and advanced WHO stage. These important and reassuring safety data stress the significance of noncommunicable disease surveillance in aging HIV populations in sub-Saharan Africa.

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Loss to follow-up correction increased mortality estimates in HIV-positive people on antiretroviral therapy in Mozambique

10.1101/2020.08.04.20167155 ◽

2020 ◽

Author(s):

Nanina Anderegg ◽

Jonas Hector ◽

Laura F Jefferys ◽

Juan Burgos-Soto ◽

Michael A Hobbins ◽

...

Keyword(s):

Risk Factors ◽

Antiretroviral Therapy ◽

Bayesian Model Averaging ◽

Clinical Stage ◽

Sub Saharan Africa ◽

People Living With Hiv ◽

Advanced Clinical Stage ◽

Cell Counts ◽

Mortality Estimates

Objectives: People living with HIV (PLWH) on antiretroviral therapy (ART) may be lost to follow-up (LTFU), which hampers the assessment of outcomes. We estimated mortality for patients starting ART in a rural region in sub-Saharan Africa and examined risk factors for death, correcting for LTFU. Study design and setting: We analysed data from Ancuabe, Mozambique, where patients LTFU are traced by phone and home visits. We used cumulative incidence functions to estimate mortality and LTFU. To correct for LTFU, we revised outcomes based on tracing data using different inverse probability weights (maximum likelihood [ML], Ridge regression or Bayesian model averaging [BMA]). We fitted competing risk models to identify risk factors for death and LTFU. Results: Analyses included 4492 patients; during 8152 person-years of follow-up, 486 patients died, 2375 were LTFU, 752 were traced, and 603 were found. At 4 years after starting ART, observed mortality was 11.9% (95% CI 10.9-13.0) but 23.5% (19.8- 28.0), 21.6% (18.7-25.0) and 23.3% (19.7-27.6) after correction with ML, Ridge and BMA weights, respectively. Risk factors for death included male sex, lower CD4 cell counts and more advanced clinical stage. Conclusion: In ART programmes with substantial LTFU, mortality estimates need to take LTFU into account.

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Incidence and Predictors of Tuberculosis among Adult PLWHA at Public Health Facilities of Hawassa City

International Journal of Public Health Science (IJPHS) ◽

10.11591/ijphs.v6i3.9294 ◽

2017 ◽

Vol 6 (3) ◽

pp. 266

Author(s):

Henok Bekele ◽

Mesfin Kote ◽

Aman Yesuf ◽

Tadele Girum

Keyword(s):

Proportional Hazards ◽

Proportional Hazards Model ◽

Clinical Stage ◽

Stage Iv ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Incidence Density ◽

People Living With Hiv ◽

Base Line

Tuberculosis (TB) is the most frequently diagnosed opportunistic infection (OI) and disease in people living with HIV/AIDS (PLWHA), world-wide. This study aimed at determining the incidence and predictors of tuberculosis among people living with HIV.A Six year retrospective follow up study was conducted among adult PLHIV. The Cox proportional hazards model was used to identify predictors.A total of 554 patients were followed and produced 1830.3 person year of observation. One hundred sixty one new TB cases occurred during the follow up period. The overall incidence density of TB was 8.79 per 100 person-year (PY). It was high (148.71/100 PY) in the first year of enrolment. The cumulative proportion of TB free survival was 79% and 67% at the end of first and sixth years, respectively. Not having formal education(AHR=2.68, 95%CI: 1.41, 5.11 ), base line WHO clinical stage IV (AHR = 3.22, 95% CI=1.91-5.41), CD4 count <50 cell/ul (AHR=2.41, 95%CI=1.31, 4.42), Being bed redden (AHR= 2.89, 95%CI=1.72, 3.78), past TB history (AHR=1.65, 95% CI = 1.06,2.39), substance use (AHR=1.46, 95% CI=1.03,2.06) and being on pre ART (AHR=1.62, 95%CI:1.03-2.54 ) were independently predicted tuberculosis occurrence. Advanced WHO clinical stage, limited functional status, past TB history, addiction and low CD4 (<50cell/ul) count at enrollment were found to be the independent predictor of tuberculosis occurrence. Therefore early initiation of treatment and intensive follow up is important.

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Failure to return pillbox is a predictor of being lost to follow‐up among people living with HIV on antiretroviral therapy in rural Tanzania

HIV Medicine ◽

10.1111/hiv.13223 ◽

2021 ◽

Author(s):

Robert C. Ndege ◽

James Okuma ◽

Aneth V. Kalinjuma ◽

Julius Mkumbo ◽

Elizabeth Senkoro ◽

...

Keyword(s):

Antiretroviral Therapy ◽

People Living With Hiv ◽

Rural Tanzania ◽

Living With Hiv ◽

Lost To Follow Up

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Causes of death and associated factors over a decade of follow-up in a cohort of people living with HIV in rural Tanzania

BMC Infectious Diseases ◽

10.1186/s12879-021-06962-3 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Getrud Joseph Mollel ◽

Lilian Moshi ◽

Hoda Hazem ◽

Anna Eichenberger ◽

Olivia Kitau ◽

...

Keyword(s):

Associated Factors ◽

Causes Of Death ◽

Proportional Hazards ◽

Cd4 Count ◽

People Living With Hiv ◽

Factors Associated ◽

Rural Tanzania ◽

Living With Hiv ◽

Related Mortality

Abstract Background Nearly half of HIV-related deaths occur in East and Southern Africa, yet data on causes of death (COD) are scarce. We determined COD and associated factors among people living with HIV (PLHIV) in rural Tanzania. Methods PLHIV attending the Chronic Diseases Clinic of Ifakara, Morogoro are invited to enrol in the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO). Among adults (≥ 15 years) enrolled in 2005–2018, with follow-up through April 2019, we classified COD in comprehensive classes and as HIV- or non-HIV-related. In the subset of participants enrolled in 2013–2018 (when data were more complete), we assessed cause-specific mortality using cumulative incidences, and associated factors using proportional hazards models. Results Among 9871 adults (65% female, 26% CD4 count < 100 cells/mm3), 926 (9%) died, among whom COD were available for 474 (51%), with missing COD mainly in earlier years. The most common COD were tuberculosis (N = 127, 27%), non-AIDS-related infections (N = 72, 15%), and other AIDS-related infections (N = 59, 12%). Cardiovascular and renal deaths emerged as important COD in later calendar years, with 27% of deaths in 2018 attributable to cardiovascular causes. Most deaths (51%) occurred within the first six months following enrolment. Among 3956 participants enrolled in 2013–2018 (N = 203 deaths, 200 with COD ascertained), tuberculosis persisted as the most common COD (25%), but substantial proportions of deaths from six months after enrolment onwards were attributable to renal (14%), non-AIDS-related infections (13%), other AIDS-related infections (10%) and cardiovascular (10%) causes. Factors associated with higher HIV-related mortality were sex, younger age, living in Ifakara town, HIV status disclosure, hospitalisation, not being underweight, lower CD4 count, advanced WHO stage, and gaps in care. Factors associated with higher non-HIV-related mortality included not having an HIV-positive partner, lower CD4 count, advanced WHO stage, and gaps in care. Conclusion Incidence of HIV-related mortality was higher than that of non-HIV-related mortality, even in more recent years, likely due to late presentation. Tuberculosis was the leading specific COD identified, particularly soon after enrolment, while in later calendar years cardiovascular and renal causes emerged as important, emphasising the need for improved screening and management.

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Gestational diabetes with diabetes and prediabetes risks: a large observational study

Acta Endocrinologica ◽

10.1530/eje-18-0130 ◽

2018 ◽

Vol 179 (1) ◽

pp. 51-58 ◽

Cited By ~ 11

Author(s):

Yun Shen ◽

Peng Wang ◽

Leishen Wang ◽

Shuang Zhang ◽

Huikun Liu ◽

...

Keyword(s):

Gestational Diabetes ◽

Observational Study ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

World Health ◽

Oral Glucose ◽

Adjusted Risk ◽

Postpartum Diabetes ◽

Incident Cases

Aims To compare risks of early postpartum diabetes and prediabetes in Chinese women with and without gestational diabetes mellitus (GDM) during pregnancy. Subjects and methods Tianjin GDM observational study included 1263 women with a history of GDM and 705 women without GDM who participated in the urban GDM universal screening survey by using World Health Organization’s criteria. Postpartum diabetes and prediabetes were identified after a standard oral glucose tolerance test. Cox proportional hazards regression was used to assess risks of postpartum diabetes and prediabetes between women with and without GDM. Results During a mean follow-up of 3.53 years postpartum, 90 incident cases of diabetes and 599 incident cases of prediabetes were identified. Multivariable-adjusted hazard ratios among women with prior GDM, compared with those without it, were 76.1 (95% CI: 23.6–246) for diabetes and 25.4 (95% CI: 18.2–35.3) for prediabetes. When the mean follow-up extended to 4.40 years, 121 diabetes and 616 prediabetes cases were identified. Women with prior GDM had a 13.0-fold multivariable-adjusted risk (95% CI: 5.54-30.6) for diabetes and 2.15-fold risk (95% CI: 1.76-2.62) for prediabetes compared with women without GDM. The positive associations between GDM and the risks of postpartum diabetes and prediabetes were significant and persistent when stratified by younger and older than 30 years at delivery and normal weight and overweight participants. Conclusions The present study indicated that women with prior GDM had significantly increased risks for postpartum diabetes and prediabetes, with the highest risk at the first 3–4 years after delivery, compared with those without GDM.

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HIV Pediatric Care Quality in Togo's Health Facilities in 2014

Journal of Child Science ◽

10.1055/s-0038-1635088 ◽

2018 ◽

Vol 08 (01) ◽

pp. e11-e17

Author(s):

K. Azoumah ◽

F. Agbéko ◽

K. Djadou ◽

K. Segbedji ◽

A. Géraldo ◽

...

Keyword(s):

Care Quality ◽

Health Facilities ◽

World Health ◽

Hiv Care ◽

Pediatric Care ◽

People Living With Hiv ◽

Average Delay ◽

Z Scores ◽

Weight For Age

AbstractIn 2013, children living with human immunodeficiency virus (HIV)(CLHIV) and on antiretroviral therapy (ART) in Togo accounted for 7.6% of people living with HIV on ART. Management faces many challenges due to insufficient qualified human resources. This study aimed to assess the availability of care offered to these children in health facilities. This was a retrospective descriptive study on 244 CLHIV (under 15 years) who were on ART and randomly selected in 26 sites providing HIV medical care in Togo from July 22 to September 06 2014. Evaluation forms on children's clinical, biological, and therapeutic parameters were analyzed. Forty percent of CLHIV were between the ages of 5 and 9 years. The average age was 5 years at testing for diagnosis; 49% of children were in the World Health Organization (WHO) stage III–IV. The sex ratio (male/female [M/F]) was 1:1. Almost 71% of CLHIV were underweight (weight-for-age < − 2 Z scores Severely underweight : weight-for-age < − 3 Z scores). The patient height was not recorded in 81.6% of the cases. According to the guidelines, the criteria to be on ART were met for 90.2% of children. The average delay (from diagnosis) to be on ART was 216 days. First-line regimens were mostly zidovudine/lamivudine/nevirapine (AZT/3TC/NVP) (47.0%) and stavudine/lamivudine/nevirapine (d4T/3TC/NVP) (38.7%). Follow-up was characterized by a low rate of achievement of the biological semi-annual evaluation (19.8%), child compliance for 62.7%, a cotrimoxazole prophylaxis for 70.2%, and tuberculosis screening for 64.8%. The lost-to-follow-up (LFU) proportion was 8.9%. HIV pediatric diagnosis is still an issue in Togo. Early maternal and child healthcare and HIV care are not optimal. Recruitment and capacity building of health professionals, delegation of tasks to paramedics, and innovative motivation processes could improve care for HIV-infected children.

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Cytomegalovirus pp65 antigenaemia as an indicator of end organ disease in AIDS

International Journal of STD & AIDS ◽

10.1258/0956462981922809 ◽

1998 ◽

Vol 9 (9) ◽

pp. 545-547 ◽

Cited By ~ 1

Author(s):

E. F. Fox ◽

N. A. Smith ◽

P. Rice ◽

H. Dunn ◽

B. S. Peters

Keyword(s):

Predictive Value ◽

Primary Prophylaxis ◽

Cd4 Cell Count ◽

Exact Test ◽

Resistant Tuberculosis ◽

Mdr Tb ◽

Cmv Disease ◽

Lost To Follow Up ◽

Cd4 Cell

We aim to assess the usefulness of the cytomegalovirus CMV pp65 antigenaemia test, also called the CMV direct antigen test DAT , in the management of patients with advanced human immunodeficiency virus HIV infection; we studied all patients who had pp65 assays between 8 September 1995 and 30 August 1996. Twenty three patients had 31 tests. The mean CD4 cell count was 20 mm 3. The tests were negative in 16 patients, of whom 12 have not developed CMV end organ disease after a mean follow up of 114 days range 14- 269 days , whilst the remaining 4 patients had previously treated CMV disease. Eleven patients had positive tests: 4 had active CMV disease, 2 subsequently developed CMV retinitis, 2 died within a fortnight of multi drug resistant tuberculosis MDR TB , one was lost to follow up and 2 have remained disease free. This test has a positive predictive value of 43 and a negative predictive value of 94 , Fisher s exact test P =0.03. The pp65 antigenaemia assay can be performed in a standard virology laboratory avoiding the problems associated with polymerase chain reaction PCR , a result is available within 5 h, and it is semi quantifiable. However, a large prospective study is required to determine the comparative value and roles of the pp65 antigenaemia assay and DNA PCR in the management of CMV disease, especially with regard to the use of primary prophylaxis and pre emptive therapy.

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Does undernutrition increase the risk of lost to follow-up in adults living with HIV in sub-Saharan Africa? Protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-048022 ◽

2021 ◽

Vol 11 (12) ◽

pp. e048022

Author(s):

Animut Alebel ◽

Daniel Demant ◽

Pammla Petrucka ◽

David Sibbritt

Keyword(s):

Systematic Review ◽

Effect Size ◽

Grey Literature ◽

Sub Saharan Africa ◽

People Living With Hiv ◽

Significance Level ◽

Sub Saharan ◽

Living With Hiv ◽

Lost To Follow Up

IntroductionUndernutrition is considered a marker for poor prognosis among people living with HIV (PLHIV), particularly in sub-Saharan Africa (SSA), where undernutrition and HIV are both highly prevalent. Evidence suggests that undernutrition (body mass index <18.5 kg/m2) is one of the main factors that significantly increases the risk of lost to follow-up (LTFU) in PLHIV. However, primary studies in SSA have reported inconsistent findings on the relationship between undernutrition and LTFU among adults living with HIV. To the best of our knowledge, no systematic review which aimed to summarise the available evidence. Hence, this review aims to determine the pooled effect of undernutrition on LTFU among adults living with HIV in SSA.Methods and analysisPubMed, EMBASE, Web of Science, Scopus, and, for grey literature, Google Scholar will be systematically searched to include relevant articles published since 2005. Studies reporting the effect of undernutrition on LTFU in adults living with HIV in SSA will be included. The Newcastle-Ottawa Scale will be used for quality assessment. Data from eligible studies will be extracted using a standardised data extraction tool. Heterogeneity between included studies will be assessed using Cochrane Q-test and I2 statistics. The Egger’s and Begg’s tests at a 5% significance level will be used to evaluate publication bias. As heterogeneity is anticipated, the pooled effect size will be estimated using a random-effects model. The final effect size will be reported using the adjusted HR with a 95% CI.Ethics and disseminationEthical approval is not required for a protocol for a systematic review. The results of this systematic review will be published in a peer-reviewed journal and will be publicly available.PROSPERO registration numberCRD42021277741.

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