Skip to main content

Free Content Low retention of HIV-infected patients on antiretroviral therapy in 11 clinical centres in West Africa

Download Article:

You have access to the full text article on a website external to Ingenta Connect.

Please click here to view this article on Wiley Online Library.

You may be required to register and activate access on Wiley Online Library before you can obtain the full text. If you have any queries please visit Wiley Online Library

Abstract:

Summary Objective 

To study factors associated with the probability of retention in antiretroviral therapy (ART) programmes in West Africa. Methods 

The International epidemiologic Databases to Evaluate AIDS (IeDEA) in West Africa is a prospective, operational, observational cohort study based on collaboration between 11 cohorts of HIV-infected adult patients in Benin, Côte d’Ivoire, Gambia, Mali and Senegal. All patients aged 16 and older at ART initiation, with documented gender and date of ART initiation, were included. For those with at least 1 day of follow-up, Kaplan–Meier method and Weibull regression model were used to estimate the 12-month probability of retention in care and the associated factors. Results 

In this data merger, 14 352 patients (61% female) on ART were included. Median age was 37 (interquartile range (IQR): 31–44 years) and median CD4 count at baseline was 131 cells/mm3 (IQR: 48–221 cells/mm3). The first-line regimen was NNRTI-based for 78% of patients, protease inhibitor-based for 17%, and three NRTIs for 3%. The probability of retention was 0.90 [95% confidence interval (CI): 0.89–0.90] at 3 months, 0.84 (95% CI: 0.83–0.85) at 6 months and 0.76 (95% CI: 0.75–0.77) at 12 months. The probability of retention in care was lower in patients with baseline CD4 count <50 cells/mm3 [adjusted hazard ratio (aHR) = 1.37; 95% CI: 1.27–1.49; P < 0.0001] (reference CD4 > 200 cells/mm3, in men (aHR = 1.17; 95% CI: 1.10–1.24; P = 0.0002), in younger patients (<30 years) (aHR = 1.10; 95% CI: 1.03–1.19; P = 0.01) and in patients with low haemoglobinaemia <8 g/dl (aHR = 1.33; 95% CI: 1.21–1.45; P < 0.0001). Availability of funds for systematic tracing was associated with better retention (aHR = 0.29; 95% CI: 0.16–0.55; P = 0.001). Conclusions 

Close follow-up, promoting early access to care and ART and a decentralized system of care may improve the retention in care of HIV-infected patients on ART.

Keywords: HIV infection; West Africa; cohort studies; loss to follow-up; mortality; retention

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-3156.2010.02505.x

Affiliations: 1:  INSERM, U897, and ISPED, Université Bordeaux 2, Bordeaux, France 2:  Centre Intégré de Recherche Bioclinique d’Abidjan (CIRBA), Abidjan, Côte d’Ivoire 3:  Service des Maladies Infectieuses et Tropicales (SMIT), Centre Hospitalier Universitaire (CHU) de Treichville, Abidjan, Côte d’Ivoire 4:  Service d’Hépato-Gastro-Entérologie, Hôpital Gabriel Touré, Bamako, Mali 5:  MTCT+ Initiative, ACONDA, Abidjan, Côte d’Ivoire 6:    CePReF, ACONDA, Abidjan Côte d’Ivoire 7:  SMIT, CHU de Fann, Dakar, Senegal 8:  Service de Medecine interne, Hôpital du point G, Bamako, Mali

Publication date: June 1, 2010

bsc/tmih/2010/00000015/A00101s1/art00003
dcterms_title,dcterms_description,pub_keyword
6
5
20
40
5

Access Key

Free Content
Free content
New Content
New content
Open Access Content
Open access content
Subscribed Content
Subscribed content
Free Trial Content
Free trial content
Cookie Policy
X
Cookie Policy
Ingenta Connect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more