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BMC Infect Dis. 2016 Feb 1;16:43. doi: 10.1186/s12879-016-1392-7.

Predictors of dropout from care among HIV-infected patients initiating antiretroviral therapy at a public sector HIV treatment clinic in sub-Saharan Africa.

Author information

1
Department of Medicine, Mbarara Regional Referral Hospital, P.O Box 40, Mbarara, Uganda. asiimwesteve@gmail.com.
2
Department of Epidemiology and Biostatistics, University of California San Francisco, California, USA. asiimwesteve@gmail.com.
3
Department of Medicine, Mbarara Regional Referral Hospital, P.O Box 40, Mbarara, Uganda. mkanyesigye2010@gmail.com.
4
Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda. mwebesa_bwana@yahoo.com.
5
Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda. okello.samson@must.ac.ug.
6
Department of Medicine, Mbarara Regional Referral Hospital, P.O Box 40, Mbarara, Uganda. wmuyindike@gmail.com.

Abstract

BACKGROUND:

In sub-Saharan Africa (SSA), antiretroviral therapy (ART) can prolong life for HIV-infected patients. However, patients initiating ART, especially in routine treatment programs, commonly dropout from care either due to death or loss to follow-up.

METHODS:

In a cohort of HIV-infected patients initiating ART at a public sector clinic in Uganda, we assessed predictors of dropout from care (a composite outcome combining death and loss to follow-up). From a large set of socio-demographic, clinical, and laboratory variables routinely collected at ART initiation, we selected those predicting dropout at P <0.1 in unadjusted analyses for inclusion into a multivariable proportional hazards regression model. We then used a stepwise backward selection procedure to identify variables which independently predicted dropout at P <0.05.

RESULTS:

Data from 5,057 patients were analyzed. The median age was 33 years (IQR 28 to 40) and 27.4% had CD4+ T-cell counts <100 cells/μL at ART initiation. The median duration of follow-up was 24 months (IQR = 14 to 42, maximum follow-up = 64 months). Overall dropout was 26.9% (established cumulative mortality = 2.3%, loss to follow-up = 24.6%), 5.6% were transferred to other service providers, and 67.5% were retained in care. A diagnosis of Kaposi's sarcoma (hazard ratio (HR) = 3.3, 95% CI 2.5 to 4.5); HIV-associated dementia (HR = 2.6, 95% CI 1.5 to 4.6); history of cryptococcosis (HR = 2.2, 95% CI 1.4 to 3.3); and reduced hemoglobin concentration (<11 g/dl versus ≥13.8 g/dl (HR = 1.9, 95% CI 1.6 to 2.2) were strong predictors of dropout. Other independent predictors of dropout were: year of ART initiation; weight loss ≥10%; reduced total lymphocyte count; chronic diarrhea; male sex; young age (≤28 years); and marital status.

CONCLUSIONS:

Among HIV-infected patients initiating ART at a public sector clinic in SSA, biological factors that usually predict death were especially predictive of dropout. As most of the dropouts were lost to follow-up, this observation suggests that many losses to follow-up may have died. Future studies are needed to identify appropriate interventions that may improve both individual-level patient outcomes and outcome ascertainment among HIV-infected ART initiators in this setting.

PMID:
26832737
PMCID:
PMC4736127
DOI:
10.1186/s12879-016-1392-7
[Indexed for MEDLINE]
Free PMC Article

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