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

Details

• Alternative Title:
  BMC Infect Dis
• Personal Author:
  Ahonkhai, Aimalohi A. ; Banigbe, Bolanle ; Adeola, Juliet ; Onwuatuelo, Ifeyinwa ; Bassett, Ingrid V. ; Losina, Elena ; Freedberg, Kenneth A. ; Okonkwo, Prosper ; Regan, Susan
• Description:
  Background
  
  Unplanned care interruption (UCI) challenges effective HIV treatment. We determined the frequency and risk factors for UCI in Nigeria.
  
  Methods
  
  We 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.
  
  Results
  
  Among 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.
  
  Discussion
  
  UCI 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.
  
  Conclusions
  
  Interventions focused on the first year on ART are needed to improve continuity of HIV care.
  
  
• Subjects:
  Adult Anti-HIV Agents CD4 Lymphocyte Count Cohort Studies Female HIV-1 HIV Infections Humans Male Multivariate Analysis Retrospective Studies Risk Factors RNA, Viral Treatment Outcome Viral Load

  More +
• Source:
  BMC Infect Dis. 15.
• Pubmed ID:
  26424505
• Pubmed Central ID:
  PMC4589963
• Document Type:
  Journal Article
• Funding:
  R01 AI058736-09S1/AI/NIAID NIH HHS/United States ; 5U2GPS001058/PHS HHS/United States ; R01 MH090326/MH/NIMH NIH HHS/United States ; K23 AI106406-02/AI/NIAID NIH HHS/United States ; 2P30AI060354/AI/NIAID NIH HHS/United States ; U2G PS001058/PS/NCHHSTP CDC HHS/United States ; K23 AI106406/AI/NIAID NIH HHS/United States ; R01 AI058736/AI/NIAID NIH HHS/United States ; P30 AI060354/AI/NIAID NIH HHS/United States
• Place as Subject:
  Nigeria
• Volume:
  15
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:e2bbdd10ada9d811fefe1469c7e4c7e58da57a8e50fa81fb20bd941dd260a593
• Download URL:
  https://stacks.cdc.gov/view/cdc/43606/cdc_43606_DS1.pdf
• File Type:
  [PDF - 567.63 KB ]