Early loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countries

Brinkhof, Martin W G; Dabis, François; Myer, Landon; Bangsberg, David R; Boulle, Andrew; Nash, Denis; Schechter, Mauro; Laurent, Christian; Keiser, Olivia; May, Margaret; Sprinz, Eduardo; Egger, Matthias; Anglaret, Xavier (2008). Early loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countries. Bulletin of the World Health Organization, 86(7), pp. 559-67. Genève: World Health Organization 10.2471/BLT.07.044248

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OBJECTIVE: To analyse the early loss of patients to antiretroviral therapy (ART) programmes in resource-limited settings. METHODS: Using data on 5491 adult patients starting ART (median age 35 years, 46% female) in 15 treatment programmes in Africa, Asia and South America with (3) 12 months of follow-up, we investigated risk factors for no follow-up after treatment initiation, and loss to follow-up or death in the first 6 months. FINDINGS: Overall, 211 patients (3.8%) had no follow-up, 880 (16.0%) were lost to follow-up and 141 (2.6%) were known to have died in the first 6 months. The probability of no follow-up was higher in 2003-2004 than in 2000 or earlier (odds ratio, OR: 5.06; 95% confidence interval, CI: 1.28-20.0), as was loss to follow-up (hazard ratio, HR: 7.62; 95% CI: 4.55-12.8) but not recorded death (HR: 1.02; 95% CI: 0.44-2.36). Compared with a baseline CD4-cell count (3) 50 cells/microl, a count < 25 cells/microl was associated with a higher probability of no follow-up (OR: 2.49; 95% CI: 1.43-4.33), loss to follow-up (HR: 1.48; 95% CI: 1.23-1.77) and death (HR: 3.34; 95% CI: 2.10-5.30). Compared to free treatment, fee-for-service programmes were associated with a higher probability of no follow-up (OR: 3.71; 95% CI: 0.97-16.05) and higher mortality (HR: 4.64; 95% CI: 1.11-19.41). CONCLUSION: Early patient losses were increasingly common when programmes were scaled up and were associated with a fee for service and advanced immunodeficiency at baseline. Measures to maximize ART programme retention are required in resource-poor countries.

Item Type:

Journal Article (Original Article)

Division/Institute:

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

UniBE Contributor:

Brinkhof, Martin; Keiser, Olivia and Egger, Matthias

ISSN:

0042-9686

ISBN:

18670668

Publisher:

World Health Organization

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 15:04

Last Modified:

09 Jun 2015 14:45

Publisher DOI:

10.2471/BLT.07.044248

PubMed ID:

18670668

Web of Science ID:

000257421900014

BORIS DOI:

10.7892/boris.27756

URI:

https://boris.unibe.ch/id/eprint/27756 (FactScience: 111428)

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