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

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

scholarly journals Cohort profile: The International epidemiology Databases to Evaluate AIDS (IeDEA) in sub-Saharan Africa, 2012-2019

2019 ◽  
Author(s):  
Frédérique Chammartin ◽  
Cam Ha Dao Ostinelli ◽  
Kathryn Anastos ◽  
Antoine Jaquet ◽  
Ellen Brazier ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Antiretroviral Therapy ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Loss To Follow Up ◽  
Sub Saharan ◽  
Treat All ◽  
Living With Hiv ◽  
International Epidemiology

ABSTRACTPurposeThe objectives of the International epidemiology Databases to Evaluate AIDS (IeDEA) are to (i) evaluate the delivery of combination antiretroviral therapy (ART) in children, adolescents and adults in sub-Saharan Africa, (ii) to describe ART regimen effectiveness, durability and tolerability, (iii) to examine HIV-related comorbidities and co-infections, and (iv) to examine the pregnancy- and HIV-related outcomes of women on ART and their infants exposed to HIV or antiretroviral therapy in utero or via breastmilk.ParticipantsIeDEA is organized in four regions (Central, East, Southern and West Africa), with 240 treatment and care sites, six data centres at African, European and US universities, and almost 1.4 million children, adolescents and adult people living with HIV (PLWHIV) enrolled.Findings to dateThe data include socio-demographic characteristics, clinical outcomes, opportunistic events, treatment regimens, clinic visits and laboratory measurements. They have been used to analyse outcomes in people living with HIV-1 or HIV-2 who initiate ART, including determinants of mortality, of switching to second-line and third-line ART, drug resistance, loss to follow-up and the immunological and virological response to different ART regimens. Programme-level estimates of mortality have been corrected for loss to follow-up. We examined the impact of co-infection with hepatitis B and C, and the epidemiology of different cancers and of (multi-drug resistant) tuberculosis, renal disease and of mental illness. The adoption of “Treat All”, making ART available to all PLWHIV regardless of CD4+ cell count or clinical stage was another important research topic.Future plansIeDEA has formulated several research priorities for the “Treat All” era in sub-Saharan Africa. It recently obtained funding to set up sentinel sites where additional data are prospectively collected on cardiometabolic risks factors as well as mental health and liver diseases, and is planning to create a drug resistance database.

scholarly journals Predictors of virological failure among people living with HIV receiving first line antiretroviral treatment in Myanmar: retrospective cohort analysis

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Anita Mesic ◽  
Alexander Spina ◽  
Htay Thet Mar ◽  
Phone Thit ◽  
Tom Decroo ◽  
...  
Keyword(s):  
Viral Load ◽  
Virological Failure ◽  
Antiretroviral Treatment ◽  
People Living With Hiv ◽  
First Line ◽  
Hiv Viral Load ◽  
Loss To Follow Up ◽  
History Of ◽  
Living With Hiv

Abstract Background Progress toward the global target for 95% virological suppression among those on antiretroviral treatment (ART) is still suboptimal. We describe the viral load (VL) cascade, the incidence of virological failure and associated risk factors among people living with HIV receiving first-line ART in an HIV cohort in Myanmar treated by the Médecins Sans Frontières in collaboration with the Ministry of Health and Sports Myanmar. Methods We conducted a retrospective cohort study, including adult patients with at least one HIV viral load test result and having received of at least 6 months’ standard first-line ART. The incidence rate of virological failure (HIV viral load ≥ 1000 copies/mL) was calculated. Multivariable Cox’s regression was performed to identify risk factors for virological failure. Results We included 25,260 patients with a median age of 33.1 years (interquartile range, IQR 28.0–39.1) and a median observation time of 5.4 years (IQR 3.7–7.9). Virological failure was documented in 3,579 (14.2%) participants, resulting in an overall incidence rate for failure of 2.5 per 100 person-years of follow-up. Among those who had a follow-up viral load result, 1,258 (57.1%) had confirmed virological failure, of which 836 (66.5%) were switched to second-line treatment. An increased hazard for failure was associated with age ≤ 19 years (adjusted hazard ratio, aHR 1.51; 95% confidence intervals, CI 1.20–1.89; p < 0.001), baseline tuberculosis (aHR 1.39; 95% CI 1.14–1.49; p < 0.001), a history of low-level viremia (aHR 1.60; 95% CI 1.42–1.81; p < 0.001), or a history of loss-to-follow-up (aHR 1.24; 95% CI 1.41–1.52; p = 0.041) and being on the same regimen (aHR 1.37; 95% CI 1.07–1.76; p < 0.001). Cumulative appointment delay was not significantly associated with failure after controlling for covariates. Conclusions VL monitoring is an important tool to improve programme outcomes, however limited coverage of VL testing and acting on test results hampers its full potential. In our cohort children and adolescents, PLHIV with history of loss-to-follow-up or those with low-viremia are at the highest risk of virological failure and might require more frequent virological monitoring than is currently recommended.

scholarly journals Survival analysis of people living with human immunodeficiency virus: a study in a teaching hospital

2020 ◽  
Vol 7 (9) ◽  
pp. 1339
Author(s):  
S. Bhagyabati Devi ◽  
T. Jeetenkumar Singh ◽  
Kshetrimayum Birendra Singh ◽  
N. Biplab Singh ◽  
Robinson Ningshen ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
People Living With Hiv ◽  
Good Adherence ◽  
National Programme ◽  
Immunodeficiency Virus ◽  
Centre Of Excellence ◽  
High Incidence ◽  
Good Nutrition ◽  
Living With Hiv

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.  

scholarly journals Re-engagement in care of people living with HIV lost to follow-up after initiation of antiretroviral therapy in Mali: Who returns to care?

PLoS ONE ◽  
2020 ◽  
Vol 15 (9) ◽  
pp. e0238687
Author(s):  
Aliou Baldé ◽  
Laurence Lièvre ◽  
Almoustapha Issiaka Maiga ◽  
Fodié Diallo ◽  
Issouf Alassane Maiga ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
People Living With Hiv ◽  
Engagement In Care ◽  
Living With Hiv ◽  
Lost To Follow Up

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.

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