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

Martin W.G. Brinkhof, François Dabis, Landon Myer, David R. Bangsberg, Andrew Boulle, Denis Nash, Mauro Schechter, Christian Laurent, Olivia Keiser, Margaret May, Eduardo Sprinz, Matthias Egger, Xavier Anglaret

Research output: Contribution to journalArticlepeer-review

260 Scopus citations

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 ≥ 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 ≥ 50 cells/μl, a count < 25 cells/μl 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.

Original languageEnglish (US)
Pages (from-to)559-567
Number of pages9
JournalBulletin of the World Health Organization
Volume86
Issue number7
DOIs
StatePublished - Jul 2008
Externally publishedYes

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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