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Home >> Publications >> Early loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countries.

Publication

Author(s):

Brinkhof MW, Dabis F, Myer L, Bangsberg DR, Boulle A, Nash D, Schechter M, Laurent C, Keiser O, May M, Sprinz E, Egger M, Anglaret X; ART-LINC, IeDEA.

Pub Title:

Early loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countries.

Pub Date:

Jul 31 2008

Pub Region(s):

Southern Africa

Journal Issue:

7

Page Number:
559-67

Journal:

Title: 
Bulletin of the World Health Organization
Link: 
http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862008000700016&lng=en&nrm=iso&tlng=en

PubMed: 18670668
Pub PDF: PDF icon 18670668.pdf

Abstract
OBJECTIVE
: To analyse the early loss of patients to antiretroviral therapy (ART) programmes in resource-limited settings.

METHODS: Using data on 5491 adult patients starting ART (median age 35 years, 46% female) in 15 treatment programmes in Africa, Asia and South America with (3) 12 months of follow-up, we investigated risk factors for no follow-up after treatment initiation, and loss to follow-up or death in the first 6 months.

FINDINGS: Overall, 211 patients (3.8%) had no follow-up, 880 (16.0%) were lost to follow-up and 141 (2.6%) were known to have died in the first 6 months. The probability of no follow-up was higher in 2003-2004 than in 2000 or earlier (odds ratio, OR: 5.06; 95% confidence interval, CI: 1.28-20.0), as was loss to follow-up (hazard ratio, HR: 7.62; 95% CI: 4.55-12.8) but not recorded death (HR: 1.02; 95% CI: 0.44-2.36). Compared with a baseline CD4-cell count (3) 50 cells/microl, a count < 25 cells/microl was associated with a higher probability of no follow-up (OR: 2.49; 95% CI: 1.43-4.33), loss to follow-up (HR: 1.48; 95% CI: 1.23-1.77) and death (HR: 3.34; 95% CI: 2.10-5.30). Compared to free treatment, fee-for-service programmes were associated with a higher probability of no follow-up (OR: 3.71; 95% CI: 0.97-16.05) and higher mortality (HR: 4.64; 95% CI: 1.11-19.41).

CONCLUSION: Early patient losses were increasingly common when programmes were scaled up and were associated with a fee for service and advanced immunodeficiency at baseline. Measures to maximize ART programme retention are required in resource-poor countries.

PMID: 18670668 [PubMed - indexed for MEDLINE]

PMCID: PMC2647487

 

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Citation:

Brinkhof MW, Dabis F, Myer L, Bangsberg DR, Boulle A, Nash D, Schechter M, Laurent C, Keiser O, May M, Sprinz E, Egger M, Anglaret X; ART-LINC, IeDEA. Early loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countries. Bull World Health Organ. 2008 Jul;86(7):559-67. PubMed PMID: 18670668; PubMed Central PMCID: PMC2647487.