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

2019 ◽  
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 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.

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

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.

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

PLoS Medicine ◽  
2011 ◽  
Vol 8 (10) ◽  
pp. e1001111 ◽  
Author(s):  
Benjamin H. Chi ◽  
Constantin T. Yiannoutsos ◽  
Andrew O. Westfall ◽  
Jamie E. Newman ◽  
Jialun Zhou ◽  
...  
Keyword(s):  
Latin America ◽  
Statistical Analysis ◽  
Hiv Treatment ◽  
Treatment Programs ◽  
Loss To Follow Up ◽  
Universal Definition ◽  
Definition Of

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

2021 ◽  
Author(s):  
Emily Koech ◽  
Kristen A Stafford ◽  
Immaculate Mutysia ◽  
Abraham Katana ◽  
Marline Jumbe ◽  
...  
Keyword(s):  
Hiv Treatment ◽  
Loss To Follow Up ◽  
Factors Associated

scholarly journals Cost-Effectiveness of Preventing Loss to Follow-up in HIV Treatment Programs: A Côte d'Ivoire Appraisal

PLoS Medicine ◽  
2009 ◽  
Vol 6 (10) ◽  
pp. e1000173 ◽  
Author(s):  
Elena Losina ◽  
Hapsatou Touré ◽  
Lauren M. Uhler ◽  
Xavier Anglaret ◽  
A. David Paltiel ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cote D'ivoire ◽  
Côte D’Ivoire ◽  
Hiv Treatment ◽  
Treatment Programs ◽  
Cote D’Ivoire ◽  
Loss To Follow Up ◽  
Côte D'ivoire

scholarly journals Time-Dependent Predictors of Loss to Follow-Up in a Large HIV Treatment Cohort in Nigeria

2014 ◽  
Vol 1 (2) ◽  
Author(s):  
Seema Thakore Meloni ◽  
Charlotte Chang ◽  
Beth Chaplin ◽  
Holly Rawizza ◽  
Oluwatoyin Jolayemi ◽  
...  
Keyword(s):  
Viral Load ◽  
Hiv Treatment ◽  
Time Dependent ◽  
World Health ◽  
Loss To Follow Up ◽  
Cell Counts ◽  
Cd4 Cell Counts ◽  
Increased Risk ◽  
Cd4 Cell

Abstract Background.  Most evaluations of loss to follow-up (LTFU) in human immunodeficiency virus (HIV) treatment programs focus on baseline predictors, prior to antiretroviral therapy (ART) initiation. As risk of LTFU is a continuous issue, the aim of this evaluation was to augment existing information with further examination of time-dependent predictors of loss. Methods.  This was a retrospective evaluation of data collected between 2004 and 2012 by the Harvard School of Public Health and the AIDS Prevention Initiative in Nigeria as part of PEPFAR-funded program in Nigeria. We used multivariate modeling methods to examine associations between CD4+ cell counts, viral load, and early adherence patterns with LTFU, defined as no refills collected for at least 2 months since the last scheduled appointment. Results.  Of 51 953 patients initiated on ART between 2004 and 2011, 14 626 (28%) were LTFU by 2012. Factors associated with increased risk for LTFU were young age, having nonincome-generating occupations or no education, being unmarried, World Health Organization (WHO) stage, having a detectable viral load, and lower CD4+ cell counts. In a subset analysis, adherence patterns during the first 3 months of ART were associated with risk of LTFU by month 12. Conclusions.  In settings with limited resources, early adherence patterns, as well as CD4+ cell counts and unsuppressed viral load, at any time point in treatment are predictive of loss and serve as effective markers for developing targeted interventions to reduce rates of attrition.

scholarly journals Factors Associated With Loss-To-Follow-Up Of Hiv-Positive Mothers And Their Infants Enrolled In Hiv Care Clinic: A Qualitative Study

2020 ◽  
Author(s):  
Samuel Lawrent Mpinganjira ◽  
Timothy Tchereni ◽  
Andrews Gunda ◽  
Victor Mwapasa
Keyword(s):  
Qualitative Study ◽  
Hiv Treatment ◽  
Health Facilities ◽  
Hiv Care ◽  
Hiv Positive ◽  
Long Distance ◽  
Care Clinic ◽  
Loss To Follow Up ◽  
Factors Associated

Abstract Background In Malawi, loss to follow-up (LTFU) of HIV-positive pregnant and postpartum women on Option B+ regimen greatly contributes to sub-optimal retention, estimated to be 74% at 12 months postpartum. This threatens Malawi’s efforts to eliminate mother-to-child transmission of HIV. We investigated factors associated with LTFU among Mother-Infant Pairs. Methods We conducted a qualitative study, nested within the “Promoting Retention Among Infants and Mothers Effectively (PRIME)” study, a 3-arm cluster randomized trial assessing the effectiveness of strategies for improving retention of mother-infant pairs in HIV care in Salima and Mangochi districts, Malawi. From July to December 2016, we traced and interviewed 19 LTFU women. In addition, we interviewed 30 healthcare workers from health facilities where the LTFU women were receiving care. Recorded interviews were transcribed, translated and then analysed using deductive content analysis. Results The following reasons were reported as contributing to LTFU: lack of support from husbands or family members; long distance to health facilities; poverty; community-level stigma; ART side effects; perceived good health after taking ART and adoption of other alternative HIV treatment options. Conclusion Our study has found multiple factors at personal, family, community and health system levels, which contribute to poor retention of mother-infant pairs in HIV care. Key words PRIME, PMTCT, loss to follow up, mother-infant pairs, retention, Option B+

scholarly journals Violence and discrimination among Ugandan residents during the COVID-19 lockdown

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elizabeth Katana ◽  
Bob Omoda Amodan ◽  
Lilian Bulage ◽  
Alex R. Ario ◽  
Joseph Nelson Siewe Fodjo ◽  
...  
Keyword(s):  
Law Enforcement ◽  
Control Measures ◽  
Sub Saharan Africa ◽  
World Health ◽  
Vulnerable Groups ◽  
Transport Systems ◽  
Outcome Variable ◽  
Cross Sectional ◽  
Factors Associated ◽  
The Past

Abstract Background In March 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. Many countries in Sub-Saharan Africa, Uganda inclusive, implemented lockdowns, curfew, banning of both private and public transport systems, and mass gatherings to minimize spread. Social control measures for COVID-19 are reported to increase violence and discrimination globally, including in Uganda as some may be difficult to implement resulting in the heavy deployment of law enforcement. Media reports indicated that cases of violence and discrimination had increased in Uganda’s communities following the lockdown. We estimated the incidence and factors associated with experiencing violence and discrimination among Ugandans during the COVID-19 lockdown to inform control and prevention measures. Methods In April 2020, we conducted a secondary analysis of cross-sectional data under the International Citizen Project (ICP) to assess adherence to public health measures and their impact on the COVID-19 outbreak in Uganda. We analyzed data on violence and discrimination from the ICP study. We performed descriptive statistics for all the participants’ characteristics and created a binary outcome variable called experiencing violence and/or discrimination. We performed logistic regression analysis to identify the factors associated with experiencing violence and discrimination. Results Of the 1726 ICP study participants, 1051 (58.8%) were males, 841 (48.7%) were currently living with a spouse or partner, and 376 (21.8%) had physically attended work for more than 3 days in the past week. Overall, 145 (8.4%) experienced any form of violence and/or discrimination by any perpetrator, and 46 (31.7%) of the 145 reported that it was perpetrated by a law enforcement officer. Factors associated with experiencing violence or discrimination were: being male (AOR = 1.60 CI:1.10–2.33), having attended work physically for more than 3 days in the past week (AOR = 1.52 CI:1.03–2.23), and inability to access social or essential health services since the epidemic started (AOR = 3.10 CI:2.14–4.50). Conclusion A substantial proportion of Ugandan residents experienced violence and/or discrimination during the COVID-19 lockdown, mostly perpetrated by law enforcement officers. We recommend mitigation of the collateral impact of lockdowns with interventions that focus on improving policing quality, ensuring continuity of essential services, and strengthening support systems for vulnerable groups including males.

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

2011 ◽  
Vol 57 ◽  
pp. S34-S39 ◽  
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

Prospective cohort study of Kaposi sarcoma treated under real-world conditions in Malawi.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 11569-11569
Author(s):  
Edwards Kasonkanji ◽  
Yolanda Gondwe ◽  
Morgan Dewey ◽  
Joe Gumulira ◽  
Matthew Painschab ◽  
...  
Keyword(s):  
Cohort Study ◽  
Kaposi Sarcoma ◽  
Median Number ◽  
Sub Saharan Africa ◽  
Worst Case ◽  
Loss To Follow Up ◽  
Presenting Symptoms ◽  
Grade 3 ◽  
Lost To Follow Up

11569 Background: Kaposi sarcoma (KS) is the leading cancer in Malawi (34% of cancers). Outside of clinical trials, prospective KS studies from sub-Saharan Africa (SSA) are few and limited by loss to follow up. We conducted a prospective KS cohort study of standard of care bleomycin/vincristine (BV) at Lighthouse HIV clinic, in Lilongwe, Malawi. Methods: We enrolled pathologically confirmed, newly diagnosed, HIV+ KS patients from Feb 2017 to Jun 2019. We collected clinical and treatment characteristics, toxicity, and outcomes of KS with follow-up censored Jun 2020. Patients were treated with bleomycin (25 mg/m2) and vincristine (0.4 mg/m2) every 14 days for a planned maximum of 16 cycles. STATA v13.0 was used to calculate descriptive statistics and Kaplan Meier survival analysis. Toxicity was graded using NCI CTCAE v5.0. Results: We enrolled 138 participants, median age 36 (IQR 32-44) and 110 (80%) male. By ACTG staging, 107 (78%) were T1 (tumour severity), 46 (33%) were S1 (illness severity) and 46 (33%) had Karnofsky performance status ≤70. Presenting symptoms included edema in 69 (53%), visceral disease in 9 (7%), and oral involvement in 43 (33%). Prior to KS diagnosis, 70 (51%) participants were aware of being HIV+ for median 17 months (IQR 6-60) and had been on ART for median 16 months (IQR 6-60). Median CD4 count was 197 (IQR 99-339), median HIV-viral load was 2.6 log copies/mL (IQR 1.6 – 4.8) and 57% were HIV-suppressed ( < 1000 HIV copies/ml). The median number of cycles was 16 (IQR 7-16). 62 (45%) participants missed at least one dose due to stock out. Amongst patients with missed doses, the median number was 3 (IQR 2-4) for bleomycin and 2 (IQR 1-3) for vincristine. 14 (10%) participants experienced at least one reduced dose due to toxicity. 5 (4%) participants suffered grade ≥3 anaemia, 13 (9%) grade ≥3 neutropenia, and one participant had grade 4 bleomycin-induced dermatitis. There was no reported grade ≥3 bleomycin lung toxicity or vincristine-induced neuropathy. Of 115 evaluable participants, responses at the end of therapy were: complete response in 52 (45%), partial response in 27 (23%) stable disease in 5 (4%), and progressive disease in 31 (28%). Median duration of follow-up was 20 months. At censoring, 69 (50%) were alive, 36 (26%) dead, and 33 (24%) lost to follow-up. Overall survival is shown Table as crude and worst-case scenario; worst-case assumes all participants lost to follow up died. Conclusions: Here, we present one of the most complete characterizations of KS presentation and treatment from SSA. As in other studies from the region, the majority of patients presented with advanced disease, chemotherapy stock-outs and loss to follow up were common, and mortality was high. Studies are planned to understand the virologic characteristics, improve therapies, and better implement existing therapies.[Table: see text]

A Retrospective Follow-up of Behaviorally Disordered Adolescents: Identifying Predictors of Treatment Outcome

1986 ◽  
Vol 11 (2) ◽  
pp. 87-97 ◽  
Author(s):  
Peter Leone ◽  
Ronald Fitzmartin ◽  
Frank Stetson ◽  
Jennifer Foster
Keyword(s):  
Academic Achievement ◽  
Treatment Outcome ◽  
Day Treatment ◽  
Treatment Programs ◽  
Successful Completion ◽  
Behaviorally Disordered ◽  
Residential Status ◽  
Factors Associated ◽  
Day Treatment Program

Behaviorally disordered adolescents are a heterogeneous group. Determining which students enrolled in particular treatment programs are likely to be successful is a difficult task. This retrospective follow-up systematically investigated behaviorally disordered youth and identified factors associated with successful completion of a comprehensive residential and day treatment program. Results suggest that, for the 70 subjects studied, attendance, day or residential status, and prior adjudication were related to treatment outcomes. A dditionally, for a subset of 34 subjects directly interviewed and assessed at follow-up, measures of academic achievement were unrelated to outcomes.

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