scholarly journals Analysis of mortality and loss to follow-up during the rollout of the second-line antiretroviral therapy: An observational study from South India

2019 ◽  
Vol 1 ◽  
pp. 19-23
Author(s):  
Kidangazhiyathmana Ajithkumar ◽  
P. C. Amrutha ◽  
Unnikrishnan C. Vinitha ◽  
T. P. Rakesh ◽  
Andrews M. Andrews
Keyword(s):  
Antiretroviral Therapy ◽  
Point Of Care ◽  
Univariate Analysis ◽  
Good Health ◽  
Second Line ◽  
Load Testing ◽  
Older Individuals ◽  
Factors Affecting ◽  
Loss To Follow Up

Background Assessment of the functioning of Kerala’s second-line component of antiretroviral therapy (ART) program by National AIDS Control Organization (NACO) is attempted. Aims This study aims to evaluate the factors related to mortality and loss to follow-up (LFU) during the second-line ART rollout in Kerala. Materials and Methods Prospective observational cohort study. All patients referred for the second-line ART from September 2011 to June 2013 were included, followed up till December 2013 or till death. Those who were not eligible to attend the State AIDS Clinical Expert Panel (SACEP) were excluded from the study. Descriptive variables were compared using proportions and percentages. Univariate analysis and multivariate logistic regression were done to find out the association. The study was approved by ethical committee and consent was taken from all the interviewed patients. Results Of 238 patients enrolled, 62 died and 25 became LFU. Age >40 years (odds ratio [OR] 2.08; 95% confidence interval [CI]: 1.05, 4.1), HIV concordance between partners (OR 1.53; 95% CI: 0.7, 3.34), and duration of >90 days from last CD4+ to SACEP (OR 2.32; 95% CI: 1.17, 4.5) were significantly associated with death. Only factor affecting LFU was distance >150 km from patient’s home to ART Plus Centre (OR: 2.7; 95% CI: 0.11, 1.85). Limitations We could not consider all factors affecting mortality while initiating second-line ART. Moreover, experience from a low-level epidemic state, with good health-care infrastructure may not reflect rest of India. Conclusions Accessibility to program in terms of distance to the point of care and delayed linkage of patients for the second-line ART is presently the main weaknesses in Kerala. Special attention should be given to concordant couples and older individuals who are more vulnerable. Recent steps by NACO, such as initiation of two ART Plus Centre and provision viral load testing at the point of care, are big leaps toward solution.

scholarly journals Incidence and predictors of early loss to follow up among patients initiated on protease inhibitor-based second-line antiretroviral therapy in southwestern Uganda

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Edwin Nuwagira ◽  
Boniface A. E. Lumori ◽  
Rose Muhindo ◽  
Michael Kanyesigye ◽  
Abdallah Amir ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Protease Inhibitor ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Second Line ◽  
Current Increase ◽  
Loss To Follow Up ◽  
Southwestern Uganda

Abstract Background Good adherence to antiretroviral therapy (ART) and retention in care are essential for the effectiveness of an HIV care program. With the current increase in numbers of people living with HIV taking second-line ART in sub-Saharan Africa, there is a need to establish their treatment outcomes and the rate of loss to follow up. In this study, we determined the incidence and predictors of loss to follow up among patients taking second-line ART at an experienced HIV treatment center in southwestern Uganda. Methods This was a retrospective review of an electronic database at Mbarara Regional Referral Hospital HIV clinic in southwestern Uganda. Second-line ART included at least two of the nucleoside reverse transcriptase inhibitors and a boosted protease inhibitor. Loss to follow-up was defined as failure to return to the health facility for care or treatment refill for 180 days or more from the previous visit. After excluding children less than 15 years, we pooled data that included socio-demographic, clinical, and laboratory data for patients who started second-line ART between 2002 and 2017. Multiple imputation was done for variables with missing data. Variables that had a p < 0.05 in unadjusted bivariate analyses were included in a multivariate binomial regression model using a stepwise backward selection procedure to describe the factors that independently predicted loss to follow-up. Results Between 2002 and 2017, 1121 patients had been initiated on second-line ART. We included data from 924 participants and of these, 518 (56.1%) were female, the mean age (SD) was 38.4 (± 10.5) years, and 433 (52.4%) had a CD4 count less than 100 cells/µl at the start of second-line ART. The incidence of loss to follow-up was 26.7 per 100 person-years. Male gender (Adjusted risk ratio (ARR) = 1.8, 95% CI 1.5–2.0) p < 0.001 and anemia ARR 1.4, 95% CI 1.1–1.6) p < 0.001 were strongly associated with loss to follow up. Conclusions There is a high incidence of loss to follow up among patients taking protease-inhibitor based second-line ART at a tertiary HIV center in southwestern Uganda. There is a need to routinely measure hemoglobin during clinic reviews, and establish mechanisms to retain males initiated on second-line ART in care. The association of anemia and loss to follow up needs to be investigated.

scholarly journals Moderate incidence of lost follow-up and risk factors among adult HIV patients on second-line ART regimens in Amhara region hospitals, Ethiopia

2019 ◽  
Vol 9 (1-s) ◽  
pp. 52-59
Author(s):  
Ahmed Mohammed ◽  
Saed Abdi ◽  
S Palani ◽  
Nisha Mary Joseph
Keyword(s):  
Risk Factors ◽  
Antiretroviral Therapy ◽  
Functional Status ◽  
Cumulative Incidence ◽  
Categorical Variables ◽  
Second Line ◽  
Amhara Region ◽  
Hiv Patients ◽  
Loss To Follow Up

Background and Objectives: Loss to follow-up is a common problem of most patients on antiretroviral therapy in Ethiopia. Second-line antiretroviral therapy is the drug that would be used when the first-line therapy fails.  Thus this study intends to determine the incidence and risk factors of time to losses to follow up among  Human  Immunodeficiency  Virus (HIV) patients on second line regimens of  Antiretroviral Therapy(ART) in Amhara region Hospitals, Ethiopia. Methods: Institutional based retrospective cohort study was conducted in the Amhara region hospitals from February to March 2016. A total of 1246 patient from eight hospitals in Amhara region were selected using simple random sampling method and data were extracted from patient charts.  The log rank test was used to assess presence of significant difference in time to losses to follow among levels of categorical variables. Both bi-variiable and multivariable Cox proportional hazards models were used to identify factors that affect the time to losses to follow up.    Results: The cumulative incidence of loss to follow up was 5.41% over the entire (eight) years of follow-up. The cumulative incidence rates of death and transfer out were 10.99%,10.02 %, respectively. In multivariable Cox regression analysis, ambulatory functional status (AHR=0.1967, 95% CI: 0.049- 0 .794), male gender (AHR=2.135, 95% CI: 1.053- 4.330),  adherence to ART (AHR=0.442, 95% CI: 0.198- 0.989) were significant predictors of time to losses to follow up. The use of 2a, 2e and 2g types of second line regimen reduced the risk of  loss to follow up. Interpretations and Conclusions: The incidence of loss to follow up in Amhara region hospitals was low. Loss to folow up was negatively  associated with female gender, ambulatory  baseline functional status, adherence, & types of second line regimen types. Further research on the effect of  types of drug is recommended by acertaining whether the reduction in loss to follow up  for patients who took drug types of 2a, 2e, and 2g is associaed with improved or worsened health outcomes by trafcking lost patients closely.  

Patient Loss to Follow-Up Before Antiretroviral Therapy Initiation in Rural Mozambique

2014 ◽  
Vol 19 (4) ◽  
pp. 666-678 ◽  
Author(s):  
Monica da Silva ◽  
Meridith Blevins ◽  
C. William Wester ◽  
José Manjolo ◽  
Eurico José ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Loss To Follow Up ◽  
Therapy Initiation

scholarly journals Determinants of loss to follow-up among HIV positive patients receiving antiretroviral therapy in a test and treat setting: A retrospective cohort study in Masaka, Uganda

PLoS ONE ◽  
2020 ◽  
Vol 15 (4) ◽  
pp. e0217606 ◽  
Author(s):  
Julius Kiwanuka ◽  
Jacinta Mukulu Waila ◽  
Methuselah Muhindo Kahungu ◽  
Jonathan Kitonsa ◽  
Noah Kiwanuka
Keyword(s):  
Cohort Study ◽  
Antiretroviral Therapy ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Hiv Positive ◽  
Loss To Follow Up ◽  
Test And Treat

scholarly journals Predictors of loss to follow-up in patients living with HIV/AIDS after initiation of antiretroviral therapy

2014 ◽  
Vol 6 (9) ◽  
pp. 453 ◽  
Author(s):  
Salahuddin Mohammed ◽  
TezeraMoshago Berheto ◽  
DemissewBerihun Haile
Keyword(s):  
Antiretroviral Therapy ◽  
Loss To Follow Up ◽  
Living With Hiv ◽  
Hiv Aids

scholarly journals 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 ◽  
2018 ◽  
Vol 20 (1) ◽  
pp. 47-53 ◽  
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

scholarly journals Loss to follow-up and mortality among HIV-infected adolescents receiving antiretroviral therapy in Pune, India

HIV Medicine ◽  
2018 ◽  
Vol 19 (6) ◽  
pp. 395-402 ◽  
Author(s):  
S Nimkar ◽  
C Valvi ◽  
D Kadam ◽  
BB Rewari ◽  
A Kinikar ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Loss To Follow Up

scholarly journals Dual Analysis of Loss to Follow-up for Perinatally HIV-Infected Adolescents Receiving Combination Antiretroviral Therapy in Asia

2019 ◽  
Vol 82 (5) ◽  
pp. 431-438
Author(s):  
Adam W. Bartlett ◽  
Pagakrong Lumbiganon ◽  
Thahira A. Jamal Mohamed ◽  
Keswadee Lapphra ◽  
Dina Muktiarti ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Combination Antiretroviral Therapy ◽  
Loss To Follow Up ◽  
Dual Analysis
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