Survival of people on antiretroviral treatment in Zambia: a retrospective cohort analysis of HIV clients on ART

The Pan African Medical Journal

Christopher Simoonga¹  Gershom Chongwe²  Rosalia Dambe²  Patrick Amanzi²  Charles Michelo² 

[1] Ministry of health, Zambia;University of Zambia, School of Medicine, Department of Public Health;

关键词: survival analysis;    retrospective cohort;    lost to follow up;   

DOI  :  10.11604/pamj.2016.24.144.6004

来源: DOAJ

【 摘 要 】

INTRODUCTION: provision of free anti-retroviral therapy in Zambia started in June 2004. There were only 15,000 people on treatment as at December that year, mainly due to lack of access. This number rose to 580,000 people as at December 2013. The general objective of this study was to determine survival of people on ART and to examine associated predictors for survival. METHODS: the study included ART patients enrolled between the year 2002 and 2013 (n=10,395) in 285 health facilities in Zambia. Patient files were analyzed retrospectively. The study used Kaplan Meier and cox-proportional hazard models to describe the relationship between lost to follow up and age, sex, baseline CD4 cell count and weight. RESULTS: results showed that lost to follow up accounted for 90% of the clients that had dropped out, while 10% due to deaths. Low baseline CD4 count (p-value 0.001, HR 0.9994, (95% CI 0.9993, 0.9996) at initiation was associated with lost to follow up together with weight at initiation (p-value 0.031, HR 0.9987 at 95% CI (0.9975, 0.9998)) of ART. CONCLUSION: this study has demonstrated that lost to follow is a substantial contributing factor to drop outs among HIV patients on treatment.Strengthening of community treatment supporters especially immediate family members in emphasizing to the client the need to continue treatment is necessary. The facility could do more in emphasizing the importance of treatment especially in the initial stages. Further, in order to reduce opportunistic infections and probable deaths during treatment, cotrimoxazole prophylaxis should be maintained so as to raise the CD4 levels.Improved nutritional assessment and counseling to boost the nutritional status of the clients throughout should be encouraged.

【 授权许可】

Unknown