Universal Definition of Loss to Follow-Up in HIV Treatment Programs: A Statistical Analysis of 111 Facilities in Africa, Asia, and Latin America

Abstract Background: The scale-up of HIV treatment programs has resulted in a reduction in HIV-related morbidity and mortality. However, retention of patients in these programs remains a challenge in sub-Saharan Africa. Understanding factors associated with loss to follow-up (LTFU) and mortality outcomes is therefore important to inform targeted program interventions. Methods: A retrospective multi-cohort analysis of 23,890 adult patients on ART over 36 months of follow-up in Kenya was done. Multivariate logistic regression analysis was done to assess for factors associated with LTFU and mortality at 6, 12, 24, and 36 months of follow-up. Results: Majority, 67.7%, were female. At 36 months , 27.2% were LTFU and 13.5% had died. Factors associated with mortality at 36 months included older age (51 years and above) using 20-35 years as reference [(adjusted odds ratio [aOR], 1.51, 95% confidence interval (CI) 1.23–1.86, p<0.001], being male (aOR, 1.59, 95% CI 1.39–1.83, p<0.001), divorced using married as reference (aOR, 1.86, 95% CI 1.56–2.22, p<0.001), having a body mass index (BMI) score of less than 18.5 kg/m² using 18.5-24.9 kg/m² as reference (aOR = 1.79, 95% CI 1.52–2.11, p<0.001), and, World Health Organization stage III and IV using stage I as the reference (aOR, 1.94, 95% CI 1.43–2.63 and aOR, 4.24, 95% CI 3.06–5.87, p<0.001 respectively). Factors associated with LTFU at 36 months included being young between 20-35 years (aOR, 1.49, 95% CI 1.40-1.59, p<0.001) using 36-50 years as reference, being male (aOR, 1.19, 95% CI 1.12–1.27, p<0.001), and being single or divorced using married as reference (aOR, 1.34, 95% CI 1.23–1.45 and aOR, 1.25, 95% CI 1.15–1.36, p<0.001 respectively). Patients with baseline BMI of less than 18.5 kg/m² using normal BMI as reference (aOR, 1.68, 95% CI 1.39–2.02, p<0.001) were also likely to be LTFU. Conclusions: Factors associated with LTFU and mortality were generally similar over time. Implementation of HIV treatment programs should therefore be tailored based on gender, age profiles, nutritional, and, marital status of patients. In addition, programs should focus on the care of older patients to reduce the risk of mortality.

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Factors associated with 36-month loss to follow-up and mortality outcomes among HIV-infected adults on antiretroviral therapy in Central Kenya

10.21203/rs.2.18191/v2 ◽

2020 ◽

Author(s):

Paul Wekesa ◽

Angela McLigeyo ◽

Kevin Owuor ◽

Jonathan Mwangi ◽

Evelyn Nganga ◽

...

Keyword(s):

Cohort Analysis ◽

Scale Up ◽

Multivariate Logistic Regression Analysis ◽

Hiv Treatment ◽

Sub Saharan Africa ◽

World Health ◽

Treatment Programs ◽

Loss To Follow Up ◽

Factors Associated

Abstract Background : The scale-up of HIV treatment programs has resulted in a reduction in HIV-related morbidity and mortality. However, retention of patients in these programs remains a challenge in sub-Saharan Africa. Understanding factors associated with loss to follow-up (LTFU) and mortality outcomes is therefore important to inform targeted program interventions. Methods : A retrospective multi-cohort analysis of 23,890 adult patients on ART over 36 months of follow-up in Kenya was done. Multivariate logistic regression analysis was done to assess for factors associated with LTFU and mortality at 6, 12, 24, and 36 months of follow-up. Results : Majority, 67.7%, were female. At 36 months , 27.2% were LTFU and 13.5% had died. Factors associated with mortality at 36 months included older age (51 years and above) using 20-35 years as reference [(adjusted odds ratio [aOR], 1.51, 95% confidence interval (CI) 1.23–1.86, p<0.001], being male (aOR, 1.59, 95% CI 1.39–1.83, p<0.001), divorced using married as reference (aOR, 1.86, 95% CI 1.56–2.22, p<0.001), having a body mass index (BMI) score of less than 18.5 kg/m² using 18.5-24.9 kg/m² as reference (aOR = 1.79, 95% CI 1.52–2.11, p<0.001), and, World Health Organization stage III and IV using stage I as the reference (aOR, 1.94, 95% CI 1.43–2.63 and aOR, 4.24, 95% CI 3.06–5.87, p<0.001 respectively). Factors associated with LTFU at 36 months included being young between 20-35 years (aOR, 1.49, 95% CI 1.40-1.59, p<0.001) using 36-50 years as reference, being male (aOR, 1.19, 95% CI 1.12–1.27, p<0.001), and being single or divorced using married as reference (aOR, 1.34, 95% CI 1.23–1.45 and aOR, 1.25, 95% CI 1.15–1.36, p<0.001 respectively). Patients with baseline BMI of less than 18.5 kg/m² using normal BMI as reference (aOR, 1.68, 95% CI 1.39–2.02, p<0.001) were also likely to be LTFU. Conclusions : Factors associated with LTFU and mortality were generally similar over time. Implementation of programs in similar settings should be tailored to gender, age profiles, nutritional, and, marital status of patients to address LTFU. In addition, programs should focus on the care of older patients to reduce the risk of mortality.

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Medication Possession Ratio: Predicting and Decreasing Loss to Follow-Up in Antiretroviral Treatment Programs in Côte dʼIvoire

JAIDS Journal of Acquired Immune Deficiency Syndromes ◽

10.1097/qai.0b013e3182208003 ◽

2011 ◽

Vol 57 ◽

pp. S34-S39 ◽

Cited By ~ 9

Author(s):

Eugène Messou ◽

Martial Kouakou ◽

Delphine Gabillard ◽

Patrice Gouessé ◽

Mamadou Koné ◽

...

Keyword(s):

Antiretroviral Treatment ◽

Medication Possession Ratio ◽

Treatment Programs ◽

Loss To Follow Up

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Predictors of loss to follow-up before HIV treatment initiation in Northwest Ethiopia: a case control study

BMC Public Health ◽

10.1186/1471-2458-13-867 ◽

2013 ◽

Vol 13 (1) ◽

Cited By ~ 16

Author(s):

Ismael Ahmed ◽

Salem T Gugsa ◽

Seblewengel Lemma ◽

Meaza Demissie

Keyword(s):

Treatment Initiation ◽

Case Control Study ◽

Case Control ◽

Northwest Ethiopia ◽

Hiv Treatment ◽

Loss To Follow Up ◽

Control Study

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Factors Associated with Loss to Follow-up among Patients Receiving HIV Treatment in Nairobi, Kenya

AIDS Research and Human Retroviruses ◽

10.1089/aid.2020.0292 ◽

2021 ◽

Author(s):

Emily Koech ◽

Kristen A Stafford ◽

Immaculate Mutysia ◽

Abraham Katana ◽

Marline Jumbe ◽

...

Keyword(s):

Hiv Treatment ◽

Loss To Follow Up ◽

Factors Associated

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Universal Definition of Myocardial Infarction: Clinical Insights

Cardiology ◽

10.1159/000371739 ◽

2015 ◽

Vol 131 (1) ◽

pp. 13-21 ◽

Cited By ~ 16

Author(s):

Luis Paiva ◽

Rui Providência ◽

Sérgio Barra ◽

Paulo Dinis ◽

Ana C. Faustino ◽

...

Keyword(s):

Myocardial Infarction ◽

Detailed Comparison ◽

Term Survival ◽

Acute Ischaemia ◽

Universal Definition ◽

Definition Of

Aims: The universal definition of myocardial infarction (MI) classifies acute ischaemia into different classes according to lesion mechanism. Our aim was to perform a detailed comparison between these different types of MI in terms of baseline characteristics, management and prognosis. Methods and Results: An observational retrospective single-centre cohort study was performed, including 1,000 consecutive patients admitted for type 1 (76.4%) or type 2 MI (23.6%). Type 2 MI patients were older, had a higher prevalence of comorbidities and worse medical status at admission. In-hospital mortality did not differ significantly between the MI groups (8.8 vs. 9.7%, p = 0.602). However, mortality during follow-up was almost 3 times higher in type 2 MIs (HR 2.75, p < 0.001). Type 2 MI was an independent all-cause mortality risk marker, adding discriminatory power to the GRACE model. Finally, important differences in traditional risk score performances (GRACE, CRUSADE) were found between both MI types. Conclusions: Several important baseline differences were found between these MI types. Regarding prognosis, long-term survival is significantly compromised in type 2 MIs, potentially translating patients' higher medical complexity and frailty. Distinction between type 1 and type 2 MI seems to have important implications in clinical practice and likely also in the results of clinical trials.

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Short-Term Rationing of Combination Antiretroviral Therapy: Impact on Morbidity, Mortality, and Loss to Follow-Up in a Large HIV Treatment Program in Western Kenya

AIDS Research and Treatment ◽

10.1155/2012/814564 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 2

Author(s):

April J. Bell ◽

Kara Wools-Kaloustian ◽

Sylvester Kimaiyo ◽

Hai Liu ◽

Adrian Katschke ◽

...

Keyword(s):

Median Number ◽

Hiv Treatment ◽

Adverse Outcomes ◽

Short Term ◽

Cox Models ◽

Western Kenya ◽

Loss To Follow Up ◽

Risk Of Mortality ◽

Short Period

Background. There was a 6-month shortage of antiretrovirals (cART) in Kenya.Methods. We assessed morbidity, mortality, and loss to follow-up (LTFU) in this retrospective analysis of adults who were enrolled during the six-month period with restricted cART (cap) or the six months prior (pre-cap) and eligible for cART at enrollment by the pre-cap standard. Cox models were used to adjust for potential confounders.Results. 9009 adults were eligible for analysis: 4,714 pre-cap and 4,295 during the cap. Median number of days from enrollment to cART initiation was 42 pre-cap and 56 for the cap (P<0.001). After adjustment, individuals in the cap were at higher risk of mortality (HR=1.21; 95% CI : 1.06–1.39) and LTFU (HR=1.12; 95% CI : 1.04–1.22). There was no difference between the groups in their risk of developing a new AIDS-defining illness (HR=0.9295% CI 0.82–1.03).Conclusions. Rationing of cART, even for a relatively short period of six months, led to clinically adverse outcomes.

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The Perceived determinants and recommendations by mothers and healthcare professionals on the Loss-To-Follow-Up in Option B+ program and child mortality in the Amhara Region, Ethiopia.

10.21203/rs.3.rs-57983/v2 ◽

2020 ◽

Author(s):

Mesfin Wudu Kassaw ◽

Samuel T. Matula ◽

Ayele Mamo ◽

Ayelign Kassie ◽

Biruk Abate

Keyword(s):

Structural Changes ◽

Hiv Transmission ◽

Psychosocial Support ◽

Healthcare Providers ◽

Hiv Treatment ◽

Great Promise ◽

Amhara Region ◽

Loss To Follow Up ◽

Multi Stakeholder

Abstract Background: The third United Nations Sustainable Development Goal includes a commitment to end AIDS-related death by 2030. In line with the Goal, Option B+ programs hold a great promise for eliminating vertical transmission of HIV. Option B+ was introduced in 2013 in Ethiopia. The Global Plan identified Ethiopia as one of 22 high priority countries requiring improvement in the prevention of mother to child HIV transmission services. Despite HIV treatment being free in Ethiopia, only 59% of children are on treatment. The discrepancies in high uptake of Option B+ and low numbers of children in Ethiopia can be attributed to Loss-to-follow-up, which is estimated from 16% to 80%. While LFTU is expected in the region, no-to-minimal evidence exists on the magnitude and its determinants, which hampers the development of interventions and strategies to reduce LFTU.Purpose: To explore the perception of mothers and healthcare providers on determinants of and recommendations to reduce LTFU and HIV exposed infants’ mortality. Methods: An explorative, descriptive qualitative study conducted in five zones in Amhara region. The sample consisted of mothers enrolled in the option B+ programs at the five referral hospitals PMTCT departments, nurses and midwives working in those departments, and HIV officers in the zonal departments. Data were collected in 2019 using in-depth interviews. Data were analyzed using content analysis and deduced to themes. Results: Overall, nine themes were identified from the interviews. Five themes represented the determinants of LTFU and mortality while four themes addressed the recommendations to reduce LFTU among mothers and their children and infant mortality. The determinants themes centered on apathy, stigma and discrimination, poor access to services, healthcare providers behavior and attitudes, and social determinants of health. While recommendations themes suggested that improving access, capitalizing on psychosocial support, education and awareness, and empowerment. Conclusions: Social and structural issues are major contributors to low retention of mothers and death of children due to HIV. A multi-stakeholder approach, including structural changes, are required to support women and their children to ensure that individuals, communities and country enjoy the full benefits of option B+ and lead to an HIV free generation.

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MINOCA: a heterogenous group of conditions associated with myocardial damage

Heart ◽

10.1136/heartjnl-2020-318269 ◽

2021 ◽

pp. heartjnl-2020-318269

Author(s):

Trisha Singh ◽

Andrew R Chapman ◽

Marc R Dweck ◽

Nicholas L Mills ◽

David E Newby

Keyword(s):

Myocardial Infarction ◽

Obstructive Coronary Artery Disease ◽

Myocardial Damage ◽

Disease Classification ◽

Heterogenous Group ◽

Diagnostic Confusion ◽

Artery Disease ◽

Universal Definition ◽

Definition Of

Myocardial infarction with non-obstructive coronary arteries (MINOCA) was first described over 80 years ago. The term has been widely and inconsistently used in clinical practice, influencing various aspects of disease classification, investigation and management. MINOCA encompasses a heterogenous group of conditions that include both atherosclerotic and non-atherosclerotic disease resulting in myocardial damage that is not due to obstructive coronary artery disease. In many ways, it is a term that describes a moment in the diagnostic pathway of the patient and is arguably not a diagnosis. Central to the definition is also the distinction between myocardial infarction and injury. The universal definition of myocardial infarction distinguishes acute myocardial infarction, including those with MINOCA, from other causes of myocardial injury by the presence of clinical evidence of ischaemia. However, these ischaemic features are often non-specific causing diagnostic confusion, and can create difficulties for patient management and follow-up. The purpose of this review is to summarise our current understanding of MINOCA and highlight important issues relating to the diagnosis, investigation and management of patients with MINOCA.

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