scholarly journals Predictors of Attrition in Patients Ineligible for Antiretroviral Therapy after Being Diagnosed with HIV: Data from an HIV Cohort Study in India

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Gerardo Alvarez-Uria ◽  
Manoranjan Midde ◽  
Raghavakalyan Pakam ◽  
Praveen Kumar Naik
Keyword(s):  
Cohort Study ◽  
Antiretroviral Therapy ◽  
Retention In Care ◽  
Sub Saharan Africa ◽  
Hiv Diagnosis ◽  
Disadvantaged Community ◽  
Middle Income ◽  
Cell Counts ◽  
Sub Saharan

In newly HIV-diagnosed patients, the CD4+ lymphocyte count is measured to determine the need for antiretroviral therapy (ART). Studies from Sub-Saharan Africa have shown that patients who are ART ineligible at the first assessment have poor retention in care, but data from other low- or middle-income countries are scarce. In this study we describe the retention in pre-ART care of 1696 patients who were ineligible for ART after being diagnosed with HIV in a cohort study in India. More than one-third of ART ineligible patients had poor retention in care, and the attrition was higher in those with longer follow-up periods. Of those patients with poor retention, only 10% came back to the clinics, and their CD4 cell counts were lower than the ones of patients retained in care. After 4.5 years of follow-up, the cumulative incidence of loss to follow-up was 50%. Factors associated with attrition were being homeless, being illiterate, belonging to a disadvantaged community, being symptomatic at the time of the HIV diagnosis, male gender, and not living near a town. Widows were given nutritional support and, therefore, had better retention in care. The results of this study highlight the need to improve the retention in care of ART ineligible patients in India.

scholarly journals Predictors of Delayed Antiretroviral Therapy Initiation, Mortality, and Loss to Followup in HIV Infected Patients Eligible for HIV Treatment: Data from an HIV Cohort Study in India

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Gerardo Alvarez-Uria ◽  
Raghavakalyan Pakam ◽  
Manoranjan Midde ◽  
Praveen Kumar Naik
Keyword(s):  
Cohort Study ◽  
Antiretroviral Therapy ◽  
Rural Areas ◽  
Hiv Treatment ◽  
Cd4 Count ◽  
Sub Saharan Africa ◽  
Hiv Patients ◽  
Disadvantaged Community ◽  
Timely Initiation ◽  
Art Initiation

Studies from Sub-Saharan Africa have shown that a substantial number of HIV patients eligible for antiretroviral therapy (ART) do not start treatment. However, data from other low- or middle-income countries are scarce. In this study, we describe the outcomes of 4105 HIV patients who became ART eligible from January 2007 to November 2011 in an HIV cohort study in India. After three years of ART eligibility, 78.4% started ART, 9.3% died before ART initiation, and 10.3% were lost to followup. Diagnosis of tuberculosis, being homeless, lower CD4 count, longer duration of pre-ART care, belonging to a disadvantaged community, being widowed, and not living near a town were associated with delayed ART initiation. Diagnosis of tuberculosis, being homeless, lower CD4 count, shorter duration of pre-ART care, belonging to a disadvantaged community, illiteracy, and age >45 years were associated with mortality. Being homeless, being single, not living near a town, having a CD4 count <150 cells/μL, and shorter duration of pre-ART care were associated with loss to followup. These results highlight the need to improve the timely initiation of ART in HIV programmes in India, especially in ART eligible patients with tuberculosis, low CD4 counts, living in rural areas, or having a low socioeconomic status.

scholarly journals Impact of Antiretroviral Therapy on Incidence of Pregnancy among HIV-Infected Women in Sub-Saharan Africa: A Cohort Study

PLoS Medicine ◽  
2010 ◽  
Vol 7 (2) ◽  
pp. e1000229 ◽  
Author(s):  
Landon Myer ◽  
Rosalind J. Carter ◽  
Monica Katyal ◽  
Patricia Toro ◽  
Wafaa M. El-Sadr ◽  
...  
Keyword(s):  
Cohort Study ◽  
Antiretroviral Therapy ◽  
Sub Saharan Africa ◽  
Sub Saharan

scholarly journals Integrating health services for HIV infection, diabetes and hypertension in sub-Saharan Africa: a cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e053412
Author(s):  
Josephine Birungi ◽  
Sokoine Kivuyo ◽  
Anupam Garrib ◽  
Levicatus Mugenyi ◽  
Gerald Mutungi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Viral Load ◽  
Hiv Infection ◽  
Integrated Care ◽  
Plasma Viral Load ◽  
Integrated Management ◽  
Retention In Care ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Sub Saharan

BackgroundHIV, diabetes and hypertension have a high disease burden in sub-Saharan Africa. Healthcare is organised in separate clinics, which may be inefficient. In a cohort study, we evaluated integrated management of these conditions from a single chronic care clinic.ObjectivesTo determined the feasibility and acceptability of integrated management of chronic conditions in terms of retention in care and clinical indicators.Design and settingProspective cohort study comprising patients attending 10 health facilities offering primary care in Dar es Salaam and Kampala.InterventionClinics within health facilities were set up to provide integrated care. Patients with either HIV, diabetes or hypertension had the same waiting areas, the same pharmacy, were seen by the same clinical staff, had similar provision of adherence counselling and tracking if they failed to attend appointments.Primary outcome measuresRetention in care, plasma viral load.FindingsBetween 5 August 2018 and 21 May 2019, 2640 patients were screened of whom 2273 (86%) were enrolled into integrated care (832 with HIV infection, 313 with diabetes, 546 with hypertension and 582 with multiple conditions). They were followed up to 30 January 2020. Overall, 1615 (71.1%)/2273 were female and 1689 (74.5%)/2266 had been in care for 6 months or more. The proportions of people retained in care were 686/832 (82.5%, 95% CI: 79.9% to 85.1%) among those with HIV infection, 266/313 (85.0%, 95% CI: 81.1% to 89.0%) among those with diabetes, 430/546 (78.8%, 95% CI: 75.4% to 82.3%) among those with hypertension and 529/582 (90.9%, 95% CI: 88.6 to 93.3) among those with multimorbidity. Among those with HIV infection, the proportion with plasma viral load <100 copies/mL was 423(88.5%)/478.ConclusionIntegrated management of chronic diseases is a feasible strategy for the control of HIV, diabetes and hypertension in Africa and needs evaluation in a comparative study.

scholarly journals The perceptions of patients on antiretroviral therapy (ART) and treatment supporters with regard to their role towards ART adherence, at ART clinics in the intermediate hospital Oshakati, Namibia

2017 ◽  
Vol 5 (1) ◽  
pp. 17 ◽  
Author(s):  
Olivia Ningeninawa Tuhadeleni ◽  
Linda Ndeshipandula Lukolo
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Transmission ◽  
Sampling Technique ◽  
Sub Saharan Africa ◽  
Treatment Programs ◽  
Clear Understanding ◽  
Art Adherence ◽  
Study Results ◽  
Sub Saharan

Background: The benefits of antiretroviral therapy (ART) are undeniable: decreased morbidity and mortality, improved clinical outcomes, and decreased HIV transmission. In recent years, there have been remarkable efforts to roll out HIV support and treatment programs, resulting in ART access to nearly 4 million people in sub-Saharan Africa. However, a decisive step in improving outcomes of these programs relies on ART adherence. This study was conducted by aiming at exploring and describing the perceptions of patients on ART and treatment supporters about their roles in ART adherence. It was carried out at Oshakati ART clinic in the Intermediate Hospital Oshakati in Oshana region, Northern Namibia.Methods: The qualitative investigation was carried out on patients on ART and treatment supporters by means of unstructured interviews through convenient sampling technique. The data were analysed by content analytical method.Results: The study results from all respondents were consolidated, which gave a clear understanding regarding adherence at the ART clinic in Intermediate Hospital Oshakati. The perceptions of patients on ART and treatment supporters with regard to their role towards ART adherence were classified based on participants’ experiences into two main themes and sub-themes, including: 1) ART patients’ perceptions around their current roles in ART adherence comprise of four sub-themes of ART patients’ perceptions about taking medication daily, perceptions about collection of medicine supply and follow-up visits, perceptions about food and medication and perceptions about support in ART treatment; 2) Treatment supporters’ perceptions about their role in ART adherence consist of four sub-themes of perceptions about follow-up visits and collection of medicine, perceptions about psychosocial and emotional support, perceptions about giving food and medication and perceptions about encouraging personal hygiene.Conclusion: Patients and treatment supporters perceived adherence as an important aspect in the success of antiretroviral treatment. Giving patients correct information, personal motivation, patients understanding of treatment, traditional and religious beliefs were among other factors perceived by treatment supporters to be impacting on ART adherence.

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