Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study.

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)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Mugglin, Catrina; Haas, Andreas; Tenthani, Lyson Nemoni; Estill, Janne Anton Markus; Egger, Matthias and 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:

12 Dec 2019 15:24

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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