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

Background: Antiretroviral therapy (ART) have changed the outlook of people living with HIV (PLHIV) by transforming the dreaded infection to a chronically manageable disease. However, there is scant of reports which analyses quantitatively the survival benefit of PLHIV under ART. Objectives of this study were to determine the survival time of adult PLHIV who are on ARV. To analyse the factors determining survival outcome of PLHIV on ARV.Methods: This was an observational study in centre of excellence (COE) ART Centre, RIMS, Imphal from April 2004 to December 2009. Details from the data entered in documents of the ART programme were followed up every 3 months for 60 months from the date of initiation of ARV. All PLHIV above 18 years of age and undergoing antiretroviral therapy were included.Results: Survival rate following initiation of ARV was found to be significantly high among PLHIV. Higher CD4 count at the time of ARV initiation had better prognosis. Mortality was high among IDUs and they had high incidence of co-infections with HCV and HBV. The currently available ARV drugs under NACO programme have better suppression of HIV, are less toxic, low pill burden. The combined regimen used in the earlier days were not much inferior to the current ARV drugs if initiated timely with proper prophylaxis of OIs, good adherence, good nutrition and timely management of toxicities and IRIS.Conclusions: Timely treatment with ARV drugs provided under the national programme with good adherence and regular follow-up improves the survival of PLHIV.

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Risk factors for loss to follow-up, transfer or death among people living with HIV on their first antiretroviral therapy regimen in Mali

HIV Medicine ◽

10.1111/hiv.12668 ◽

2018 ◽

Vol 20 (1) ◽

pp. 47-53 ◽

Cited By ~ 1

Author(s):

A Baldé ◽

L Lièvre ◽

AI Maiga ◽

F Diallo ◽

IA Maiga ◽

...

Keyword(s):

Risk Factors ◽

Antiretroviral Therapy ◽

People Living With Hiv ◽

Loss To Follow Up ◽

Therapy Regimen ◽

Living With Hiv

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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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Predictors of Mortality among Patients Lost to Follow up Antiretroviral Therapy

Jurnal NERS ◽

10.20473/jn.v13i1.6568 ◽

2018 ◽

Vol 13 (1) ◽

pp. 114 ◽

Cited By ~ 2

Author(s):

Putu Dian Prima Kusuma Dewi ◽

Gede Budi Widiarta

Keyword(s):

Incidence Rate ◽

Median Time ◽

Secondary Data ◽

Primary Data ◽

People Living With Hiv ◽

Risk Of Death ◽

Living With Hiv ◽

Lost To Follow Up

Introduction: The death of HIV/AIDS patients after receiving therapy in Bali is the seventh highest percentage of deaths in Indonesia. LTFU increases the risk of death in PLHA, given the saturation of people with HIV taking medication. The level of consistency in the treatment is very important to maintain the resilience and quality of life of people living with HIV. This study aims to determine the incidence rate, median time and predictors of death occurring in LTFU patients as seen from their sociodemographic and clinical characteristics.Methods: This study used an analytical longitudinal approach with retrospective secondary data analysis in a cohort of HIV-positive patients receiving ARV therapy at the Buleleng District Hospital in the period 2006-2015. The study used the survival analysis available within the STATA SE 12 softwareResults: The result showed that the incidence rate of death in LTFU patients was 65.9 per 100 persons, with the median time occurrence of 0.2 years (2.53 months). The NNRTI-class antiretroviral evapirens agents were shown to increase the risk of incidence of death in LTFU patients 3.92 times greater than the nevirapine group (HR 3.92; p = 0.007 (CI 1.46-10.51). Each 1 kg increase in body weight decreased the risk of death in LTFU patients by 6% (HR 0.94; p = 0.035 (CI 0.89-0.99).Conclusion: An evaluation and the monitoring of patient tracking with LTFU should be undertaken to improve sustainability. Furthermore, an observation of the LTFU patient's final condition with primary data and qualitative research needs to be done so then it can explore more deeply the reasons behind LTFU.

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Lost but not forgotten: A population-based study of mortality and care trajectories among people living with HIV who are lost to follow-up in Ontario, Canada

HIV Medicine ◽

10.1111/hiv.12682 ◽

2018 ◽

Vol 20 (2) ◽

pp. 88-98

Author(s):

CE Kendall ◽

J Raboud ◽

J Donelle ◽

M Loutfy ◽

SB Rourke ◽

...

Keyword(s):

Population Based ◽

People Living With Hiv ◽

Population Based Study ◽

Living With Hiv ◽

Lost To Follow Up

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Determinants of loss to follow-up among people living with HIV on antiretroviral therapy in Nigeria

African Journal of AIDS Research ◽

10.2989/16085906.2021.1874444 ◽

2021 ◽

Vol 20 (1) ◽

pp. 93-99

Author(s):

Farouq Muhammad Dayyab ◽

Fahad Mukhtar ◽

Garba Iliyasu ◽

Abdulrazaq Garba Habib

Keyword(s):

Antiretroviral Therapy ◽

People Living With Hiv ◽

Loss To Follow Up ◽

Living With Hiv

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

American Journal of Epidemiology ◽

10.1093/aje/kwaa176 ◽

2020 ◽

Author(s):

Fiona Vanobberghen ◽

Maja Weisser ◽

Bryson Kasuga ◽

Andrew Katende ◽

Manuel Battegay ◽

...

Keyword(s):

Proportional Hazards ◽

Clinical Stage ◽

World Health ◽

People Living With Hiv ◽

Hospital Inpatient ◽

Cd4 Cell Count ◽

Rural Tanzania ◽

Lost To Follow Up ◽

Mortality Estimates

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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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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876. Renal Function, Lipid Profile, and Cardiovascular Events After Switching to Abacavir Containing Regimen in Antiretroviral-Therapy-Experienced People Living with HIV in Northern Thailand

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.1071 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S529-S530

Author(s):

Pitchaporn Phudphong ◽

Quanhathai Kaewpoowat ◽

Vuddhidej Ophascharoensuk ◽

Saowaluck Yasri

Keyword(s):

Renal Function ◽

Antiretroviral Therapy ◽

Lipid Profile ◽

Cardiovascular Events ◽

Demographic Data ◽

Developed Countries ◽

People Living With Hiv ◽

Northern Thailand ◽

Living With Hiv

Abstract Background Abacavir (ABC) is commonly used as part of antiretroviral therapy (ART) regimen for people living with HIV (PLWH) with renal dysfunction in resource limiting countries. While the renal function changes and association with cardiovascular (CV) events have been well described in developed countries, these information is limited in Asian population. Herein, this study aims to describe the changes in renal function, lipid profile and CV events after ABC switching in ART-experienced PLWH in Northern Thailand. Methods This retrospective chart-review study was conducted among adults ART-experienced PLWH (≥18 years old) who received ABC-containing regimen during January 2016 to December 2018 at Maharaj Nakorn Chiang Mai Hospital. Demographic data, HIV-related treatments, creatinine, lipid profile and CV events were collected. Patients were categorized into early switching group and late switching group (CrCl≥50 ml/min and CrCl< 50 ml/min before switching to ABC). The change of CrCl, urinalysis profiles, lipid profiles, CD4, viral load, and cardiovascular events at 12 months after ABC initiation were assessed. Results Total of 115 participants were enrolled with mean age of 55.2±10.7 years and 63.5% were male. Of those, 87.8% of patients had received Tenofovir disoproxil fumarate (TDF) prior to ABC. Mean of CrCl at baseline was 47.6±16.8 ml/min and at 12th month was 49.56±19.42 ml/min with mean difference of 3.7 ml/min (95%CI 1.6-5.8, P< 0.001). The improvement of CrCl at 12 months in early switching group was statistically significant compared to late switching. Other two associated factors with improved CrCl after switching to ABC were duration of TDF exposure during CrCl< 60 ml/min (OR 9.26, P 0.004) and history of protease inhibitors (PIs) exposure (OR 0.06, P 0.03). No significant changed in lipid profile, CD4 and virological outcome overtime. There were only 2 CV events observed (9.3:1000 person-year, 95%CI 2.3-37.1). Figure. (1) Creatinine clearance (ml/min) during follow up period. (2) Triglyceride (mg/dl) during follow-up period. (3) Total cholesterol (mg/dl) during follow up period. (4) LDL (mg/dl) during follow up period. (5) HDL (mg/dl) during follow up period. (6) CD4 (cells/mm3) during follow up period Conclusion ABC used in Thai ART-experienced PLWH appeared to be effective with low CV event in the first year. Despite the statistically significant in the change of CrCl after ABC switching, the change was subtle and need further evaluation. Disclosures All Authors: No reported disclosures

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