8 research outputs found
Patient Retention and Adherence to Antiretrovirals in a Large Antiretroviral Therapy Program in Nigeria: A Longitudinal Analysis for Risk Factors
Substantial resources and patient commitment are required to successfully scale-up antiretroviral therapy (ART) and provide appropriate HIV management in resource-limited settings. We used pharmacy refill records to evaluate risk factors for loss to follow-up (LTFU) and non-adherence to ART in a large treatment cohort in Nigeria.We reviewed clinic records of adult patients initiating ART between March 2005 and July 2006 at five health facilities. Patients were classified as LTFU if they did not return >60 days from their expected visit. Pharmacy refill rates were calculated and used to assess non-adherence. We identified risk factors associated with LTFU and non-adherence using Cox and Generalized Estimating Equation (GEE) regressions, respectively. Of 5,760 patients initiating ART, 26% were LTFU. Female gender (p < 0.001), post-secondary education (p = 0.03), and initiating treatment with zidovudine-containing (p = 0.004) or tenofovir-containing (p = 0.05) regimens were associated with decreased risk of LTFU, while patients with only primary education (p = 0.02) and those with baseline CD4 counts (cell/ml(3)) >350 and <100 were at a higher risk of LTFU compared to patients with baseline CD4 counts of 100-200. The adjusted GEE analysis showed that patients aged <35 years (p = 0.005), who traveled for >2 hours to the clinic (p = 0.03), had total ART duration of >6 months (p<0.001), and CD4 counts >200 at ART initiation were at a higher risk of non-adherence. Patients who disclosed their HIV status to spouse/family (p = 0.01) and were treated with tenofovir-containing regimens (p < or = 0.001) were more likely to be adherent.These findings formed the basis for implementing multiple pre-treatment visit preparation that promote disclosure and active community outreaching to support retention and adherence. Expansion of treatment access points of care to communities to diminish travel time may have a positive impact on adherence
Characteristics of the Study Population (N = 5760).
<p>Characteristics of the Study Population (N = 5760).</p
Modeled Probability of Non-adherence within the First 12 Months of ART Initiation.
<p>Modeled Probability of Non-adherence within the First 12 Months of ART Initiation.</p
Associations with Pharmacy Refill (Rx) <95% Among Treatment-Naïve Adult Nigerian Patients based on GEE.
a<p>Totals do not always sum to 4,529 due to missing data;</p>b<p>A total of 3,136 subjects included in the adjusted model; OR, odds ratio; CI, confidence interval.</p
Cox Regression Analyses of Characteristics Associated with Loss to Follow-Up (LTFU) Among Treatment-Naïve Adult Nigerian Patients.
a<p>Totals always do not sum to 5,760 due to missing data;</p>b<p>A total of 4,177 subjects included in the adjusted model; HR, hazard ratio; CI, confidence interval.</p
Study Population of Patients Initiating ART between March 2005 and July 2006.
<p>Study Population of Patients Initiating ART between March 2005 and July 2006.</p