Mugglin, Catrina; Haas, Andreas D; van Oosterhout, Joep J; Msukwa, Malango; Tenthani, Lyson; Estill, Janne; Egger, Matthias; Keiser, Olivia (2019). Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study. PLoS ONE, 14(11), e0224837. Public Library of Science 10.1371/journal.pone.0224837
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OBJECTIVES
We examine long-term retention of adults, adolescents and children on antiretroviral therapy under different HIV treatment guidelines in Malawi.
DESIGN
Prospective cohort study.
SETTING AND PARTICIPANTS
Adults and children starting ART between 2005 and 2015 in 21 health facilities in southern Malawi.
METHODS
We used survival analysis to assess retention at clinic level, Cox regression to examine risk factors for loss to follow up, and competing risk analysis to assess long-term outcomes of people on antiretroviral therapy (ART).
RESULTS
We included 132,274 individuals in our analysis, totalling 270,256 person years of follow up (PYFU; median per patient 1.3, interquartile range (IQR) 0.26-3.1), 62% were female and the median age was 32 years. Retention on ART was lower in the first year on ART compared to subsequent years for all guideline periods and age groups. Infants (0-3 years), adolescents and young adults (15-24 years) were at highest risk of LTFU. Comparing the different calendar periods of ART initiation we found that retention improved initially, but remained stable thereafter.
CONCLUSION
Even though the number of patients and the burden on health care system increased substantially during the study period of rapid ART expansion, retention on ART improved in the early years of ART provision, but gains in retention were not maintained over 5 years on ART. Reducing high attrition in the first year of ART should remain a priority for ART programs, and so should addressing poor retention among adolescents, young adults and men.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM) |
UniBE Contributor: |
Mugglin, Catrina Andrea, Haas, Andreas, Tenthani, Lyson Nemoni, Estill, Janne Anton Markus, Egger, Matthias, Keiser, Olivia |
Subjects: |
600 Technology > 610 Medicine & health 300 Social sciences, sociology & anthropology > 360 Social problems & social services |
ISSN: |
1932-6203 |
Publisher: |
Public Library of Science |
Language: |
English |
Submitter: |
Andrea Flükiger-Flückiger |
Date Deposited: |
22 Nov 2019 11:25 |
Last Modified: |
25 Mar 2024 05:23 |
Publisher DOI: |
10.1371/journal.pone.0224837 |
PubMed ID: |
31725750 |
BORIS DOI: |
10.7892/boris.135276 |
URI: |
https://boris.unibe.ch/id/eprint/135276 |
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