High rates of unplanned interruptions from HIV care early after antiretroviral therapy initiation in Nigeria

BMC Infectious Diseases

Research Article

Ifeyinwa Onwuatuelo¹  Bolanle Banigbe¹  Prosper Okonkwo¹  Juliet Adeola¹  Aimalohi A. Ahonkhai²  Ingrid V. Bassett³  Kenneth A. Freedberg⁴  Elena Losina⁵  Susan Regan⁶ 

[1] AIDS Prevention Initiative in Nigeria (APIN), Abuja, Nigeria;Division of Infectious Disease, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, USA;Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA;Division of Infectious Disease, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, USA;Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA;Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA;Harvard University Center for AIDS Research (CFAR), Boston, MA, USA;Division of Infectious Disease, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, USA;Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA;Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA;Harvard University Center for AIDS Research (CFAR), Boston, MA, USA;Departments of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, MA, USA;Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA;Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA;Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA;Departments of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, MA, USA;Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA;Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA;Harvard University Center for AIDS Research (CFAR), Boston, MA, USA;

关键词: Retention;    Unplanned care interruption;    Gaps in care;    Resource-limited setting;    HIV;   

DOI  :  10.1186/s12879-015-1137-z

 received in 2015-02-10, accepted in 2015-09-21,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundUnplanned care interruption (UCI) challenges effective HIV treatment. We determined the frequency and risk factors for UCI in Nigeria.MethodsWe conducted a retrospective-cohort study of adults initiating antiretroviral therapy (ART) between January 2009 and December 2011. At censor, patients were defined as in care, UCI, or inactive. Associations between baseline factors and UCI rates were quantified using Poisson regression.ResultsAmong 2,496 patients, 44 % remained in care, 35 % had ≥1 UCI, and 21 % became inactive. UCI rates were higher in the first year on ART (39/100PY), than the second (19/100PY), third (16/100PY), and fourth (14/100PY) years (p < 0.001). In multivariate analysis, baseline CD4 > 350/uL (IRR 3.21, p < 0.0001), being a student (IRR 1.95, p < 0.0001), and less education (IRR 1.58, p = 0.001) increased risk for UCI. Fifty-five percent of patients with UCI and viral load data had HIV viral load > 1,000 copies/ml upon return to care.DiscussionUCI were observed in over one-third of patients treated, and were most common in the first year on ART. High baseline CD4 count at ART initiation was the greatest predictor of subsequent UCI.ConclusionsInterventions focused on the first year on ART are needed to improve continuity of HIV care.

【 授权许可】

CC BY   
© Ahonkhai et al. 2015