Attrition from antiretroviral treatment services among pregnant and non-pregnant patients following adoption of Option B+ in Haiti

Details

• Alternative Title:
  Glob Health Action
• Personal Author:
  Domercant, Jean Wysler ; Puttkammer, Nancy ; Young, Paul ; Yuhas, Krista ; François, Kesner ; Grand’Pierre, Reynold ; Lowrance, David ; Adler, Michelle
• Description:
  Access to antiretroviral therapy (ART) has expanded in Haiti because of the adoption of Option B+ and the revision of treatment guidelines. Retention in care and treatment varies greatly and few studies have examined retention rates, particularly among women enrolled in Option B+.|To assess attrition among pregnant and non-pregnant patients initiating ART following adoption of Option B+ in Haiti.|Longitudinal data of adult patients initiated on ART from October 2012 through August 2014 at 73 health facilities across Haiti were analyzed using a survival analysis framework to determine levels of attrition. The Kaplan-Meier method and Cox proportional hazards regression were used to examine risk factors associated with attrition.|Among 17,059 patients who initiated ART, 7627 (44.7%) were non-pregnant women, 5899 (34.6%) were men, and 3533 (20.7%) were Option B+ clients. Attrition from the ART program was 36.7% at 12 months (95% CI: 35.9-37.5%). Option B+ patients had the highest level of attrition at 50.4% at 12 months (95% CI: 48.6-52.3%). While early HIV disease stage at ART initiation was protective among non-pregnant women and men, it was a strong risk factor among Option B+ clients. In adjusted analyses, key protective factors were older age (p < 0.0001), living near the health facility (p = 0.04), having another known HIV-positive household member (p < 0.0001), having greater body mass index (BMI) (p < 0.0001), pre-ART counseling (p < 0.0001), and Cotrimoxazole prophylaxis during baseline (p < 0.01). Higher attrition was associated with rapidly starting ART after enrollment (p < 0.0001), anemia (p < 0.0001), and regimen tenofovir+lamivudine+nevirapine (TDF+3TC+NVP) (p < 0.001).|ART attrition in Haiti is high among adults, especially among Option B+ patients. Identifying newly initiated patients most at risk for attrition and providing appropriate interventions could help reduce ART attrition.
• Subjects:
  Adult Age Factors Antiretroviral Therapy, Highly Active ART Article Attrition Female HIV HIV Infections HIV Seropositivity Humans Kaplan-Meier Estimate Longitudinal Studies Male Middle Aged Option B+ Original Article Patient Acceptance Of Health Care Patient Dropouts Practice Guidelines As Topic Pregnancy Pregnancy Complications, Infectious Proportional Hazards Models Risk Factors Severity Of Illness Index

  More +
• Source:
  Glob Health Action. 2017; 10(1).
• DOI:
  http://dx.doi.org/10.1080/16549716.2017.1330915
• Pubmed ID:
  28640661
• Pubmed Central ID:
  PMC5496080
• Document Type:
  Journal Article
• Funding:
  PEPFAR/PEPFAR/United States ; U2G GH001130/GH/CGH CDC HHS/United States
• Name as Subject:
  United States. President's Emergency Plan For AIDS Relief (PEPFAR)
• Place as Subject:
  Haiti
• Volume:
  10
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:a6e7ec0322077360b3c25c852366c39bee6d272676171f8bb1f360003148280de177f1285eb9cafdac47895749b88a8bb261fa5ff3bae0e37cf09e07208dba75
• Download URL:
  https://stacks.cdc.gov/view/cdc/61185/cdc_61185_DS1.pdf
• File Type:
  [PDF - 1.13 MB ]