scholarly journals Predicting the loss to follow-up of HIV-infected patients on ART in a rural area in South Africa using generalized gamma distributions

2021 ◽  
Author(s):  
Pepukai Bengura
Keyword(s):  
Risk Factors ◽  
South Africa ◽  
Viral Load ◽  
Marital Status ◽  
Art Adherence ◽  
Aids Patients ◽  
Loss To Follow Up ◽  
Generalized Gamma ◽  
Hiv Aids

Abstract Background - Long-term regular follow-up and high retention are the anticipated outcomes for the wellness and longevity of HIV/AIDS patients on antiretroviral treatment. However, these anticipated outcomes are marred by patient loss to follow-up (LTFU) which is currently exacerbated by the Covid-19 pandemic. This study aims to determine the prevalence and potential risk factors to LTFU among HIV/AIDS patients on ART at two rural district hospitals in South Africa.Methods— This is a retrogressive observational study whereby a cohort of HIV/AIDS patients was retrospectively followed from 2010 to 2017 until loss to follow-up occurred or until the end of the observation period at Carolina and Embhuleni hospitals. An institutional based retrospective cohort study was undertaken among children, adolescents and adults living with HIV/AIDS and attending ART clinic between January 1, 2010 and June 30, 2017. Loss to follow up was defined as not taking an ART refill for a period of 90 days or longer from the last attendance for refill and not yet classified as ‘dead’ or ‘transferred-out’ patient. Patient information was obtained from the routine hospitals’ records, and the data were analysed using Generalized gamma distribution to identify the predictors of loss to follow up among HIV/AIDS patients while Kaplan-Meier model was used to estimate and compare the LTFU survival probabilities of heterogenous groups among the patients.Results— Of the 357 patients, 60.5% were female. The mean (SD) age of the cohort was 36.2 (14.1), 15.4 (3.5), and 5.1 (3.5) years for adults, adolescents, and children, respectively. From 357 HIV/AIDS patients, 93 (26.05%) were lost to follow-up. Empirical results show that the Weibull distribution gives the best fit to the data. The Weibull model determined the Factors associated with significant risk factors to patient loss to follow up as: regimen EFV+D4T+3TC [HR: 2.0 CI;(1.3–3.1)], regimen EFV+AZT+3TC [HR: 2.9 CI;(1.3–6.4)], regimen EFV+3TC+TDF [HR: 10.0 CI;(3.9–25.9)], regimen NVP+3TC+TDF [HR: 10.6 CI;(1.8–62.4)], follow up CD4 [HR: 1.0 CI;(1.0–1.0)], log(follow up viral load) [HR: 0.8 CI;(0.7–0.9)], marital status (married) [HR: 0.4 CI;(0.3–0.8)], marital status (cohabitation) [HR: 0.6 CI;(0.3–0.9)], ART adherence (fair) [HR: 2.4 CI;(1.3–3.4)], ART adherence (good) [HR: 4.6 CI;(2.2–9.5)] and age [HR: 1.02 CI;(1.0–1.04)]. Discussion— Effective control and tracing measures in the at-risk population and in defaulters need to be stepped up especially during this COVID-19 period, to improve retention in hospitals. There is also need for careful adherence counseling and assessment of medication supplies.Conclusion— LTFU is more pronounced among females and is highest among adolescents. Patients with increased risk for LTFU were consistent with ART regimens, viral load, age, CD4 count, adherence and marital status.

Predicting the loss to follow-up of HIV-infected patients on ART in a rural area in South Africa using generalized gamma distributions

2021 ◽  
Author(s):  
Pepukai Bengura
Keyword(s):  
Risk Factors ◽  
South Africa ◽  
Viral Load ◽  
Marital Status ◽  
Art Adherence ◽  
Aids Patients ◽  
Loss To Follow Up ◽  
Generalized Gamma ◽  
Hiv Aids

Abstract Background - Long-term regular follow-up and high retention are the anticipated outcomes for the wellness and longevity of HIV/AIDS patients on antiretroviral treatment. However, these anticipated outcomes are marred by patient loss to follow-up (LTFU) which is currently exacerbated by the Covid-19 pandemic. This study aims to determine the prevalence and potential risk factors to LTFU among HIV/AIDS patients on ART at two rural district hospitals in South Africa.Methods— This is a retrogressive observational study whereby a cohort of HIV/AIDS patients was retrospectively followed from 2010 to 2017 until loss to follow-up occurred or until the end of the observation period at Carolina and Embhuleni hospitals. An institutional based retrospective cohort study was undertaken among children, adolescents and adults living with HIV/AIDS and attending ART clinic between January 1, 2010 and June 30, 2017. Loss to follow up was defined as not taking an ART refill for a period of 90 days or longer from the last attendance for refill and not yet classified as ‘dead’ or ‘transferred-out’ patient. Patient information was obtained from the routine hospitals’ records, and the data were analysed using Generalized gamma distribution to identify the predictors of loss to follow up among HIV/AIDS patients while Kaplan-Meier model was used to estimate and compare the LTFU survival probabilities of heterogenous groups among the patients.Results— Of the 357 patients, 60.5% were female. The mean (SD) age of the cohort was 36.2 (14.1), 15.4 (3.5), and 5.1 (3.5) years for adults, adolescents, and children, respectively. From 357 HIV/AIDS patients, 93 (26.05%) were lost to follow-up. Empirical results show that the Weibull distribution gives the best fit to the data. The Weibull model determined the Factors associated with significant risk factors to patient loss to follow up as: regimen EFV+D4T+3TC [HR: 2.0 CI;(1.3–3.1)], regimen EFV+AZT+3TC [HR: 2.9 CI;(1.3–6.4)], regimen EFV+3TC+TDF [HR: 10.0 CI;(3.9–25.9)], regimen NVP+3TC+TDF [HR: 10.6 CI;(1.8–62.4)], follow up CD4 [HR: 1.0 CI;(1.0–1.0)], log(follow up viral load) [HR: 0.8 CI;(0.7–0.9)], marital status (married) [HR: 0.4 CI;(0.3–0.8)], marital status (cohabitation) [HR: 0.6 CI;(0.3–0.9)], ART adherence (fair) [HR: 2.4 CI;(1.3–3.4)], ART adherence (good) [HR: 4.6 CI;(2.2–9.5)] and age [HR: 1.02 CI;(1.0–1.04)]. Discussion— Effective control and tracing measures in the at-risk population and in defaulters need to be stepped up especially during this COVID-19 period, to improve retention in hospitals. There is also need for careful adherence counseling and assessment of medication supplies.Conclusion— LTFU is more pronounced among females and is highest among adolescents. Patients with increased risk for LTFU were consistent with ART regimens, viral load, age, CD4 count, adherence and marital status.

scholarly journals Factors associated with chronic kidney disease in HIV+ patients in Albert Luthuli Municipality of South Africa

2020 ◽  
Author(s):  
PEPUKAI BENGURA ◽  
Principal Ndlovu ◽  
Mulalo Annah Managa
Keyword(s):  
Risk Factors ◽  
South Africa ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Antiretroviral Treatment ◽  
P Value ◽  
Aids Patients ◽  
Factors Associated ◽  
Research Findings ◽  
Hiv Aids

Abstract Background: Current research indicates that chronic kidney disease is a global problem which poses a major health threat to people of poor countries who have HIV/AIDS and are on antiretroviral treatment. In this study, the prevalence of chronic kidney disease and the factors associated with it were investigated among the HIV/AIDS patients in a rural community of South Africa. Methods: A cohort of HIV+ terminal ill patients was retrospectively followed from 2010 to 2017 until chronic kidney disease was diagnosed or until the end of the observation period at two hospitals (Carolina and Embhuleni). Patient information was obtained from the routine hospitals’ records, and the data were analysed using logistic regression and survival analysis (Kaplan-Meier hazard functions and ratios, and log-rank tests) methods. Results: Out of a random sample of 357 HIV/AIDS patients, 53 patients (14.85%) had chronic kidney disease. The factors associated with chronic kidney disease were: Gender (p-value<0.0024); Age (p-value<0.0420); Baseline creatinine (p-value<0.0116); Baseline alanine transaminase (p-value<0.0111); Treatment regimen 1 (p-value<0.0001); ART adherence (poor, fair, good) (p-value<0.0005); Hospital (p-value<0.0001); and Lost to follow-up (ye, no) (p-value<0.0069). Discussion: Whilst antiretroviral treatment is associated with some improvement in virology and immunology in HIV-infected patients, research is still needed for the assessment of the impact of ART and other risk factors on renal function in marginalised communities in Africa. Conclusion: The research findings on HIV+ patients in Albert Luthuli Municipality concurred with several previous research findings on risk factors to CKD. The expected action to alleviate the health threat due to CKD in South Africa is to educate the nation on prevention, early detection and on the management of the disease. The study established diverse baseline statistics against which future research may be based.

scholarly journals The HIV care cascade for adolescents initiated on antiretroviral therapy in a health district of South Africa: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Roxanna Haghighat ◽  
Elona Toska ◽  
Nontuthuzelo Bungane ◽  
Lucie Cluver
Keyword(s):  
South Africa ◽  
Viral Load ◽  
Antiretroviral Therapy ◽  
Viral Suppression ◽  
Hiv Care ◽  
Loss To Follow Up ◽  
Hiv Care Cascade ◽  
Care Cascade ◽  
Clinical Records

Abstract Background Little evidence exists to comprehensively estimate adolescent viral suppression after initiation on antiretroviral therapy in sub-Saharan Africa. This study examines adolescent progression along the HIV care cascade to viral suppression for adolescents initiated on antiretroviral therapy in South Africa. Methods All adolescents ever initiated on antiretroviral therapy (n=1080) by 2015 in a health district of the Eastern Cape, South Africa, were interviewed in 2014–2015. Clinical records were extracted from 52 healthcare facilities through January 2018 (including records in multiple facilities). Mortality and loss to follow-up rates were corrected for transfers. Predictors of progression through the HIV care cascade were tested using sequential multivariable logistic regressions. Predicted probabilities for the effects of significant predictors were estimated by sex and mode of infection. Results Corrected mortality and loss to follow-up rates were 3.3 and 16.9%, respectively. Among adolescents with clinical records, 92.3% had ≥1 viral load, but only 51.1% of viral loads were from the past 12 months. Adolescents on ART for ≥2 years (AOR 3.42 [95%CI 2.14–5.47], p< 0.001) and who experienced decentralised care (AOR 1.39 [95%CI 1.06–1.83], p=0.018) were more likely to have a recent viral load. The average effect of decentralised care on recent viral load was greater for female (AOR 2.39 [95%CI 1.29–4.43], p=0.006) and sexually infected adolescents (AOR 3.48 [95%CI 1.04–11.65], p=0.043). Of the total cohort, 47.5% were recorded as fully virally suppressed at most recent test. Only 23.2% were recorded as fully virally suppressed within the past 12 months. Younger adolescents (AOR 1.39 [95%CI 1.06–1.82], p=0.017) and those on ART for ≥2 years (AOR 1.70 [95%CI 1.12–2.58], p=0.013) were more likely to be fully viral suppressed. Conclusions Viral load recording and viral suppression rates remain low for ART-initiated adolescents in South Africa. Improved outcomes for this population require stronger engagement in care and viral load monitoring.

scholarly journals 1038. Rapid Start: A Changing Algorithm for the Management of HIV Infection

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S549-S549
Author(s):  
Smitha Gudipati ◽  
Miriam Jaziri ◽  
Stephanie Tancer ◽  
Amit T Vahia ◽  
Indira Brar
Keyword(s):  
Risk Factors ◽  
Viral Load ◽  
Standard Of Care ◽  
Heterosexual Transmission ◽  
Categorical Variables ◽  
People Living With Hiv ◽  
Hiv Diagnosis ◽  
Loss To Follow Up ◽  
Hiv 1

Abstract Background Initiating combination antiretroviral therapy (cART) as early as the day of HIV diagnosis is a strategy of increasing interest to control the HIV epidemic and optimize the health of people living with HIV. Pilot studies have shown that starting cART immediately after diagnosis has led to earlier linkage to care and HIV-1 RNA suppression. However, there is some evidence from observational studies that starting cART on the same day as HIV diagnosis may increase the risk of loss to follow-up. Consequently, there is a need for additional data for immediate cART initiation. Methods A Retrospective cohort study was conducted from 2016 to 2018 to identify clinical characteristics and risk factors in patients that were diagnosed with HIV-1 with a 4th generation assay using electronic medical records. Rapid start was defined as offering cART prior to or on the first clinic visit. Categorical variables were analyzed using chi-sq test and continuous variables were analyzed using t-test. Data analysis was done using SAS 9.4. Results In the study period, 188 patients were identified as HIV-1 positive and cART naïve: 152 males and 34 females. Risk factors included men who have sex with men (N = 86), heterosexual transmission (N = 88), intravenous drug use (N = 18) and multiple partners (N = 15). Of the 188 patients, 40 patients were rapidly started on cART on average within 6 days of diagnosis vs 42 days in the standard of care patients (P &gt; 0.0001), with a shorter duration to clinic follow up over time (P = 0.3103). 50% patients that were rapid started on cART maintained an undetectable viral load vs 77% of the standard of care group (P = 0.3174). 90% of the rapid start patients were retained in care at 12 months vs 78% of the standard of care patients (P = 0.4950). 126 patients were started on single tablet regimens (P = 0.0001) with a trend favoring bictegravir, emtricitabine & tenofovir alafenamide (P = 0.0001). Conclusion Our study adds to the growing data that rapid ART initiation within seven days of HIV diagnosis could reduce loss to follow-up, improve virological suppression rates, and reduce mortality. The percentage of patients with undetectable HIV-1 viral load and retained in care was comparable to that in standard of care, indicating that starting cART immediately after diagnosis was well accepted by patients. Disclosures Indira Brar, MD, Gilead (Speaker’s Bureau)janssen (Speaker’s Bureau)ViiV (Speaker’s Bureau)

scholarly journals Identification of factors affecting the survival lifetime of HIV+ terminal patients in Albert Luthuli municipality of South Africa

2021 ◽  
Author(s):  
Pepukai Bengura ◽  
Prince Ndlovu ◽  
Annah Mulalo Managa
Keyword(s):  
South Africa ◽  
Regression Analysis ◽  
Viral Load ◽  
Quantile Regression ◽  
Baseline Viral Load ◽  
Art Adherence ◽  
Factors Affecting ◽  
Regression Modelling ◽  
Quantile Regression Analysis

Abstract Background: South Africa has the biggest HIV epidemic in the world, with Mpumalanga province in which Albert Luthuli municipality is located having the second highest HIV prevalence rate after KwaZulu-Natal province. The objective of the study was to identify the factors that affect the survival lifetime of HIV+ terminal patients in rural district hospitals of Albert Luthuli municipality.Methods: This is a typical retrospective cohort longitudinal design study whereby cohort of HIV+ terminal patients was retrospectively followed from 2010 to 2017 until a patient died, transferred to another hospital, lost to follow-up or was still alive at the end of the observation period. The follow-up time for each patient started at the time the patient got initiated to the ART programme at the hospital’s wellness centre. Nonparametric survival analysis and semiparametric survival analysis methods were used to analyse the data.Results: Through Cox proportional hazards regression modelling, it was found that ART adherence (poor, fair, good), Age, Follow-up mass, Baseline sodium, Baseline viral load, Follow CD4 count by Treatment (Regimen 1) interaction and Follow-up lymphocyte by TB history (yes, no) interaction had significant effects on survival lifetime of HIV+ terminal patients (p-values < 0.1). Furthermore, through quantile regression modelling, it was found that short, medium and long survival times of HIV+ patients, respectively represented by the 0.1, 0.5 and 0.9 quantiles, were not necessarily significantly affected by the same factors.Discussion: The Cox PH modelling and the quantile regression analysis complemented each other in answering the research question. However, although the Cox PH modelling was the main approach in this study, the quantile regression analysis results are more informative than the Cox PH modelling results.Conclusion: The study identified and modelled the factors affecting the survival of HIV+ terminal patients in Albert Luthuli Municipality by using Logistic regression, Cox PH regression, and Quantile regression modelling. . Cox regression modelled the factors affecting the survival lifetime of HIV+ terminal patients as: ART adherence, Age, Follow-up mass, Baseline sodium, Baseline viral load and interactions of Follow-up lymphocyte by TB history and Follow-up CD4 by Treatment (Regimen 1).

scholarly journals Accelerated failure time modelling of Tuberculosis predictors in HIV/AIDS patients in Albert Luthuli Municipality of South Africa

2020 ◽  
Author(s):  
Pepukai Bengura ◽  
Principal Ndlovu ◽  
Mulalo Annah Managa
Keyword(s):  
Public Health ◽  
South Africa ◽  
Failure Time ◽  
Accelerated Failure Time ◽  
Aids Patients ◽  
Factors Associated ◽  
Aft Model ◽  
Accelerated Failure ◽  
Hiv Aids

Abstract Background: Tuberculosis (TB) is one of the most common opportunistic diseases and leading cause of death among Human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) patients. There has been a drastic rise of TB infection associated with the pandemic occurrence of HIV/AIDS infection in South Africa and other resource-limited countries world-wide. South Africa faces an immense burden on health care systems posed by diagnostic and therapeutic challenges resulting from the concomitant HIV and TB epidemics. This study aimed to determine the prevalence and the factors associated with TB and HIV co-infection for patients attending clinical care at rural public health facilities in Albert Luthuli municipality of South Africa. Methods: A cohort of HIV/AIDS patients was retrospectively followed from inception in 2010 to 2017 until TB was diagnosed or until the end of the study. Accelerated Failure Time (AFT) model was used to analyse survival data on HIV/AIDS patients. Factors associated to TB were modelled using log-logistic AFT model and further analysis of the significant factors was done using Kaplan-Meier, log-rank and hazard ratios. Results: From 357 HIV/AIDS patients, 65 patients (18.2%) had TB. Out of the 65 HIV/AIDS patients with TB, 15 (23.1%) of them died. Thus, of the 41 HIV/AIDS patients who died during the follow-up period, 15 of them (36.6%) had TB. Log-logistic AFT model determined factors associated with TB at significance level of 0.05 as: hospital, WHO stage, treatment (regimen 1), ART adherence, follow-up CD4 count, baseline haemoglobin, follow-up white blood cell count, baseline viral load, baseline sodium and follow-up alanine transaminase. Discussion: Although antiretroviral therapy is effective in reducing the risk of developing TB, the overall burden of TB in HIV/AIDS community may not substantially diminish.Conclusion: TB/HIV co-infection is one of the serious public health problems in Albert Luthuli municipality. Collaborative TB/HIV activities in form of early diagnosis of both TB and HIV need a holistic approach in order to reduce drug resistance, drug toxicity, co-morbidities and mortalities which are associated with TB/HIV co-infection.

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