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 <35years (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 (>1month), (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.

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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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    ABSTRACT: Background. Decentralization of antiretroviral therapy (ART) services is a key strategy to achieving universal access to treatment for people living with HIV/AIDS. Our objective was to assess clinical and laboratory outcomes within a decentralized program in Nigeria. Methods. Using a tiered hub-and-spoke model to decentralize services, a tertiary hospital scaled down services to 13 secondary-level hospitals using national and program guidelines. We obtained sociodemographic, clinical, and immunovirologic data on previously antiretroviral drug nave patients aged ≥15 years that received HAART for at least 6 months and compared treatment outcomes between the prime and satellite sites. Results. Out of 7,747 patients, 3729 (48.1%) were enrolled at the satellites while on HAART, prime site patients achieved better immune reconstitution based on CD4+ cell counts at 12 (íµí±ƒ < 0.001) and 24 weeks (íµí±ƒ < 0.001) with similar responses at 48 weeks (íµí±ƒ = 0.11) and higher rates of viral suppression (<400 c/mL) at 12 (íµí±ƒ < 0.001) and 48 weeks (íµí±ƒ = 0.03), but similar responses at 24 weeks (íµí±ƒ = 0.21). Mortality was 2.3% versus 5.0% (íµí±ƒ < 0.001) at prime and satellite sites, while transfer rate was 8.7% versus 5.5% (íµí±ƒ = 0.001) at prime and satellites. Conclusion. ART decentralization is feasible in resource-limited settings, but efforts have to be intensified to maintain good quality of care.
    Full-text · Article · Jun 2014 · AIDS research and treatment
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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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    Full-text · Article · Aug 2011 · AIDS (London, England)
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