Predictors of dropout from care among HIV-infected patients initiating antiretroviral therapy at a public sector HIV treatment clinic in sub-Saharan Africa

BMC Infectious Diseases

Research Article

Winnie Muyindike¹  Michael Kanyesigye¹  Stephen B. Asiimwe²  Bosco Bwana³  Samson Okello³ 

[1] Department of Medicine, Mbarara Regional Referral Hospital, P.O Box 40, Mbarara, Uganda;Department of Medicine, Mbarara Regional Referral Hospital, P.O Box 40, Mbarara, Uganda;Department of Epidemiology and Biostatistics, University of California San Francisco, California, USA;Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda;

关键词: HIV treatment;    Dropout;    Loss to follow-up;    Antiretroviral therapy;    Sub-Saharan Africa;    Predictors;   

DOI  :  10.1186/s12879-016-1392-7

 received in 2015-09-21, accepted in 2016-01-27,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundIn sub-Saharan Africa (SSA), antiretroviral therapy (ART) can prolong life for HIV-infected patients. However, patients initiating ART, especially in routine treatment programs, commonly dropout from care either due to death or loss to follow-up.MethodsIn a cohort of HIV-infected patients initiating ART at a public sector clinic in Uganda, we assessed predictors of dropout from care (a composite outcome combining death and loss to follow-up). From a large set of socio-demographic, clinical, and laboratory variables routinely collected at ART initiation, we selected those predicting dropout at P <0.1 in unadjusted analyses for inclusion into a multivariable proportional hazards regression model. We then used a stepwise backward selection procedure to identify variables which independently predicted dropout at P <0.05.ResultsData from 5,057 patients were analyzed. The median age was 33 years (IQR 28 to 40) and 27.4 % had CD4+ T-cell counts <100 cells/μL at ART initiation. The median duration of follow-up was 24 months (IQR = 14 to 42, maximum follow-up = 64 months). Overall dropout was 26.9 % (established cumulative mortality = 2.3 %, loss to follow-up = 24.6 %), 5.6 % were transferred to other service providers, and 67.5 % were retained in care. A diagnosis of Kaposi’s sarcoma (hazard ratio (HR) = 3.3, 95 % CI 2.5 to 4.5); HIV-associated dementia (HR = 2.6, 95 % CI 1.5 to 4.6); history of cryptococcosis (HR = 2.2, 95 % CI 1.4 to 3.3); and reduced hemoglobin concentration (<11 g/dl versus ≥13.8 g/dl (HR = 1.9, 95 % CI 1.6 to 2.2) were strong predictors of dropout. Other independent predictors of dropout were: year of ART initiation; weight loss ≥10 %; reduced total lymphocyte count; chronic diarrhea; male sex; young age (≤28 years); and marital status.ConclusionsAmong HIV-infected patients initiating ART at a public sector clinic in SSA, biological factors that usually predict death were especially predictive of dropout. As most of the dropouts were lost to follow-up, this observation suggests that many losses to follow-up may have died. Future studies are needed to identify appropriate interventions that may improve both individual-level patient outcomes and outcome ascertainment among HIV-infected ART initiators in this setting.

【 授权许可】

CC BY   
© Asiimwe et al. 2016