Article

Vital status of pre-ART and ART patients defaulting from care in rural Malawi

Médecins Sans Frontières, Chiradzulu, Malawi.
Tropical Medicine & International Health (Impact Factor: 2.3). 06/2010; 15 Suppl 1:55-62. DOI: 10.1111/j.1365-3156.2010.02504.x
Source: PubMed

ABSTRACT To ascertain the outcome of pre-Antiretroviral therapy (ART) and ART patients defaulting from care and investigate reasons for defaulting.
Patients defaulting from HIV care in Chiradzulu between July 2004 and September 2007 were traced at last known home address. Deaths and moves were recorded, and patients found alive were interviewed. Defaulting was defined as missed last appointment by more than 1 month among patients of unknown vital status.
A total of 1637 individuals were traced (54%-88% of eligible), 981 pre-ART and 656 ART patients. Of 694 pre-ART patients found, 49% had died (51% of adults and 38% of children), a median of 47 days after defaulting, and 14% had moved away. Of 451 ART patients found, 54% had died (54% of adults and 50% of children), a median of 52 days after defaulting, and 20% had moved away. Overall, 221 patients were interviewed (90% of those found alive), 42% had worked outside the district in the previous year; 49% of pre-ART and 19% of ART patients had not disclosed their HIV status to other household members. Main reasons for defaulting were stigma (43%), care dissatisfaction (34%), improved health (28%) and for ART discontinuation, poor understanding of disease or treatment (56%) and drug side effects (42%).
This study in a rural African HIV programme reveals the dynamics related to health service access and use, and it provides information to correct programme mortality estimates for adults and children.

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    • "Tropical Medicine & International Health Published by John Wiley & Sons Ltd. 5 Tropical Medicine and International Health volume 00 no 00 L. S. Wilkinson et al. LTFU self-transfer and mortality in LMICs Table 1 (Continued) No. First author/ Year Study period Location Setting Sector Study population age No. sites in cohort LTFU definition for tracing purposes Tracing method No. start ART in study cohort No. LTFU (%) No. in tracing study (%) 14 McGuire et al. (2010) 2004– 2007 "
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    ABSTRACT: Objective To ascertain estimates of adult patients, recorded as lost to follow-up (LTFU) within antiretroviral treatment (ART) programmes, who have self-transferred care, died or truly stopped ART in low- and middle-income countries.Methods PubMed, EMBASE, Web of Science, Science Direct, LILACS, IndMed and AIM databases (2003-2013) and IAS/AIDS conference abstracts (2011-2013) were searched for tracing studies reporting the proportion of traced patients found to have self-transferred, died or stopped ART. These estimates were then combined using random-effects meta-analysis. Risk of bias was assessed through subgroup and sensitivity analyses.Results28 studies were eligible for inclusion, reporting true outcomes for 10,806 traced patients attending approximately 258 ART facilities. None were from outside sub-Saharan Africa. 23 studies reported 4.5-54.4% traced LTFU patients self-transferring care, providing a pooled estimate of 18.6% (95% CI 15.8-22.0%). A significant positive association was found between rates of self-transfer and LTFU in the ART cohort. The pooled estimates for unreported deaths was 38.8% (95% CI 30.8-46.8%; 27 studies), and 28.6% (95% CI 21.9-36.0%; 20 studies) for patients stopping ART. A significant decrease in unreported deaths from 50.0% (95% CI 41.5-58.4%) to 30.0% (95% CI 21.1-38.9%) was found comparing study periods before and after 31/12/2007.Conclusions Substantial unaccounted for transfers and deaths among patients LTFU confirms that retention and mortality is underestimated where the true outcomes of LTFU patients are not ascertained.This article is protected by copyright. All rights reserved.
    Tropical Medicine & International Health 11/2014; 20(3). DOI:10.1111/tmi.12434 · 2.30 Impact Factor
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    • "Many clinical need factors demonstrated statistical significance across visit groups. While risk of becoming LTFU has been attributed to a poor clinical status at ART initiation [12], [14], [17], [18], [20], [23], [25]–[28], findings from the present study indicate that clinical status matters both in terms of whether a patient returns for more than one FU visit, as well as if they return Early, On Time, or Late. WHO stage at initiation was also associated with the number of follow-up visits with a higher proportion of patients in the only one follow-up visit group who initiated ART at WHO stage 4. Importantly, a late WHO stage at initiation has been associated with an increased risk of attrition and death [12], [18], [25], [56], [70]. "
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    PLoS ONE 07/2014; 9(7):e101875. DOI:10.1371/journal.pone.0101875 · 3.23 Impact Factor
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    • "In Ethiopia, stigma and preference for traditional medicine and “holy water” were cited as some of the reasons for loss to follow-up from ART clinics [45]. In Malawi, it was found that stigma led to non-retention in 25% of patients on ART [56]. In Uganda, it was found that 1.2% of patients discontinued ART because of a belief in spiritual healing [57]. "
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    Globalization and Health 05/2014; 10(1):43. DOI:10.1186/1744-8603-10-43 · 1.83 Impact Factor
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