Demographic characteristics and opportunistic diseases associated with attrition during preparation for antiretroviral therapy in primary health centres in Kibera, Kenya

Medecins sans Frontieres, Medical Department (Operational Research), Brussels Operational Center, Luxembourg, Luxembourg.
Tropical Medicine & International Health (Impact Factor: 2.33). 02/2011; 16(5):579-84. DOI: 10.1111/j.1365-3156.2011.02740.x
Source: PubMed


Using routine data from HIV-positive adult patients eligible for antiretroviral therapy (ART), we report on routinely collected demographic characteristics and opportunistic diseases associated with pre-ART attrition (deaths and loss to follow-up). Among 2471 ART eligible patients, enrolled between January 2005 and November 2008, 446(18%) were lost to attrition pre-ART. Adjusted risk factors significantly associated with pre-ART attrition included age <35 years (Odds Ratio, OR 1.4, 95% Confidence Interval, CI 1.1–1.8), severe malnutrition (OR 1.5, 95% CI 1.1–2.0), active pulmonary tuberculosis (OR 1.6, 95% CI 1.1–2.4), severe bacterial infections including severe bacterial pneumonia (OR 1.9, 95% CI 1.2–2.8) and prolonged unexplained fever (>1 month), (OR 2.6, 95% CI 1.3–5.2). This study highlights a number of clinical markers associated with pre-ART attrition that could serve as ‘pointers’ or screening tools to identify patients who merit fast-tracking onto ART and/or closer clinical attention and follow-up.
En utilisant les données de routine de patients adultes VIH séropositifs éligibles pour un traitement antirétroviral (ART), nous présentons les caractéristiques démographiques et les maladies opportunistes systématiquement recueillies, qui sont associées à l’attrition pré-ART (décès et perdus au suivi). Parmi les 2.471 patients éligibles pour l’ART, inscrits entre janvier 2005 et novembre 2008, 446 (18%) ont été perdus lors l’attrition pré-ART. Les facteurs de risque ajustés significativement associés à l’attrition pré-ART comprenaient l’âge <35 ans (Odds Ratio, OR: 1,4; intervalle de confiance à 95%, IC: 1.1–1.8), la malnutrition sévère (OR: 1,5; IC95%: 1.1–2.0), une tuberculose pulmonaire active (OR: 1.6; IC95%: 1.1–2.4), des infections bactériennes sévères, y compris la pneumonie bactérienne sévère (OR: 1.9; IC95%: 1.2–2.8) et une fièvre prolongée inexpliquée, >un mois (OR: 2.6; IC95%: 1.3–5.2). Cette étude met en évidence un certain nombre de marqueurs cliniques associés à l’attrition pré-ART qui pourraient servir de “pointeurs” ou comme outils de dépistage pour identifier les patients qui méritent une procédure accélérée pour commencer l’ART et/ou une attention clinique et un suivi plus étroits.
Utilizando datos rutinarios de pacientes adultos VIH positivos, elegibles para terapia antirretroviral (TAR), reportamos las características demográficas recogidas de forma rutinaria así como las enfermedades oportunistas asociadas con el abandono antes de comenzar TAR (muertes y pérdidas durante el seguimiento). Entre 2471 pacientes elegibles para el TAR, incluidos entre Enero 2005 y Noviembre 2008, 446(18%) fueron perdidos antes de comenzar el TAR. Los factores de riesgo ajustados asociados significativamente con la pérdida antes de comenzar el TAR incluían tener una edad <35 años (OR 1.4, 95%, IC 1.1–1.8), la desnutrición severa (OR 1.5, 95% IC 1.1–2.0), la tuberculosis pulmonar activa (OR 1.6, 95% IC 1.1–2.4), infecciones bacterianas severas incluyendo la neumonía bacteriana severa (OR 1.9, 95% IC 1.2–2.8) y la fiebre prolongada de origen desconocido (>un mes), (OR 2.6, 95% IC 1.3–5.2). Este estudio resalta un número de marcadores clínicos asociados con la pérdida de pacientes antes de que estos comenzaran el TAR, que podrían servir como “indicadores” o como herramientas de cribado para identificar pacientes que justifican un ingreso rápido en el TAR y/o una atención clínica y seguimiento más cercanos.

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    • "Timely initiation of ART in patients enrolling for care has implications for early mortality, loss to follow-up, and other outcomes during subsequent follow-ups. Delays in initiation of ART could be due to health system, or patient-related factors, including pre-ART attrition and system-mandated delays to allow for appropriate pretreatment counseling [35, 36]. These delays were associated with excess rates of preventable morbidity and mortality, especially in ART-eligible patients with advanced HIV disease who are already at elevated risk of death. "
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    AIDS research and treatment 06/2014; 2014. DOI:10.1155/2014/560623
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    • "The design of some studies may explain why the proportion of patients with a CD4 cell count differed (Larson et al. 2010b; Kohler et al. 2011; Pepper et al. 2011). Larson et al. distinguished between measured and completed CD4 cell count testing: 84.6% of the HIV positive patients had a CD4 cell count measured but only 53.1% of the eligible, and 45.7% of the not yet eligible ART eligible patients Loss to programme ART ineligible patients Loss to follow-up Mortality Overall with estimated prediction interval Tayler-Smith 2010 Murphy 2010 Lawn 2006 Zachariah 2011 Pepper 2011 Mc Grath 2010 Bassett 2009 Togun 2011 Ingle 2010 Amuron 2009 Tayler-Smith 2011 24.57 (18.81, 30.33) 24.52 (21.44, 27.90) 26.53 (16.07, 40.51) 15.47 (13.55, 17.59) 20.78 (20.14, 21.44) 40.54 (31.82, 49.90) 13.90 (11.42, 16.82) 16.97 (13.93, 20.51) 35.44 (32.18, 38.84) 35.79 (35.16, 36.43) "
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    Tropical Medicine & International Health 09/2012; 17(12). DOI:10.1111/j.1365-3156.2012.03089.x · 2.33 Impact Factor
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    AIDS (London, England) 08/2011; 25(17):2177-81. DOI:10.1097/QAD.0b013e32834b6464 · 5.55 Impact Factor
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