High rates of unplanned interruptions from HIV care early after antiretroviral therapy initiation in Nigeria
Published Date:Sep 30 2015
Source:BMC Infect Dis. 15.
Pubmed Central ID:PMC4589963
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
Unplanned care interruption (UCI) challenges effective HIV treatment. We determined the frequency and risk factors for UCI in Nigeria.
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.
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.
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.
Interventions focused on the first year on ART are needed to improve continuity of HIV care.
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