Early loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countries
Meyers Primary Care Institute; Department of Family Medicine and Community Health
Adolescent; Adult; Africa; Antiretroviral Therapy, Highly Active; Asia; CD4 Lymphocyte Count; Continuity of Patient Care; *Developing Countries; Female; HIV Infections; *HIV-1; Health Services Accessibility; Humans; International Cooperation; Logistic Models; Male; Middle Aged; Patient Acceptance of Health Care; Program Evaluation; Proportional Hazards Models; Public Health Informatics; Risk Factors; South America
Health Services Research | Primary Care
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.
Bull World Health Organ. 2008 Jul;86(7):559-67.
Bulletin of the World Health Organization
Brinkhof MW, Dabis F, Myer L, Bangsberg DR, Boulle A, Nash D, Schechter M, Laurent C, Keiser O, May M, Sprinz E, Egger M, Anglaret X. (2008). Early loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countries. Meyers Primary Care Institute Publications. Retrieved from https://escholarship.umassmed.edu/meyers_pp/561