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AIDS and Behavior
Published in: AIDS and Behavior 4/2015

01-04-2015 | Original Paper

Patient Loss to Follow-Up Before Antiretroviral Therapy Initiation in Rural Mozambique

Authors: Monica da Silva, Meridith Blevins, C. William Wester, José Manjolo, Eurico José, Lazaro C. Gonzalez, Bryan E. Shepherd, Troy D. Moon, Lara M. E. Vaz

Published in: AIDS and Behavior | Issue 4/2015

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Abstract

Within Mozambique’s current HIV care system, there are numerous opportunities for a person to become lost to follow-up (LTFU) prior to initiating antiretroviral therapy (pre-ART). We explored pre-ART LTFU in Zambézia province utilizing quantitative and qualitative methods. Patients were deemed LTFU if they were more than 60 days late for either a scheduled appointment or a CD4+ cell count blood draw, according to national guidelines. Among 13,968 adult patients registered for care, 211 (1.8 %) died, one transferred, 2,196 (15.7 %) initiated ART, and 9,195 (65.8 %) were LTFU during the first year. Being male, younger, less educated, and/or having no home electricity were associated with LTFU. Qualitative interviews revealed that poor clinical care, logistics and competing priorities contribute to attrition. In addition, many expressed fears of stigma and/or rejection by family or community members because they were HIV-infected. At 66 %, pre-ART LTFU in Zambézia, Mozambique is a significant problem. This study highlights characteristics of lost patients and discusses barriers requiring consideration to improve retention.
Literature
1.
World Health Organization. Antiretroviral therapy for HIV infection in adults and adolescents. Recommendations for a public health approach. Geneva, Switzerland: Author;2010.
2.
World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach. Geneva, Switzerland: Author;2013.
3.
Wester CWBH, Koeth J, Moffat C, Vermund S, Essex M, Marlink RG. Combination antiretroviral therapy in sub-Saharan Africa: lessons from Botswana and future challenges. HIV Ther. 2009;3(5):501–26.CrossRefPubMedCentralPubMed
4.
5.
6.
Mugglin C, Estill J, Wandeler G, Bender N, Egger M, Gsponer T, et al. Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub-Saharan Africa: systematic review and meta-analysis. Trop Med Int Health. 2012;17(12):1509–20.CrossRefPubMedCentralPubMed
7.
8.
Giordano TP, Gifford AL, White AC Jr, Suarez-Almazor ME, Rabeneck L, Hartman C, et al. Retention in care: a challenge to survival with HIV infection. Clin Infect Dis. 2007;44(11):1493–9.CrossRefPubMed
9.
Clouse K, Pettifor A, Maskew M, Bassett J, Van Rie A, Gay C, et al. Initiating antiretroviral therapy when presenting with higher CD4 cell counts results in reduced loss to follow-up in a resource-limited setting. Aids. 2013;27(4):645–50.CrossRefPubMedCentralPubMed
10.
Severe P, Juste MA, Ambroise A, Eliacin L, Marchand C, Apollon S, et al. Early versus standard antiretroviral therapy for HIV-infected adults in Haiti. N Engl J Med. 2010;363(3):257–65.CrossRefPubMedCentralPubMed
11.
Lessells RJ, Mutevedzi PC, Cooke GS, Newell ML. Retention in HIV care for individuals not yet eligible for antiretroviral therapy: rural KwaZulu-Natal, South Africa. J Acquir Immune Defic Syndr. 2011;56(3):e79–86.CrossRefPubMedCentralPubMed
12.
Grinsztejn B, Hosseinipour MC, Ribaudo HJ, Swindells S, Eron J, Chen YQ, et al. Effects of early versus delayed initiation of antiretroviral treatment on clinical outcomes of HIV-1 infection: results from the phase 3 HPTN 052 randomised controlled trial. Lancet Infect Dis. 2014;14(4):281–90.CrossRefPubMedCentralPubMed
13.
Pati R, Lahuerta M, Elul B, Okamura M, Alvim MF, Schackman B, et al. Factors associated with loss to clinic among HIV patients not yet known to be eligible for antiretroviral therapy (ART) in Mozambique. J Int AIDS Soc. 2013;16:18490.CrossRefPubMedCentralPubMed
14.
Geng EH, Bwana MB, Muyindike W, Glidden DV, Bangsberg DR, Neilands TB, et al. Failure to initiate antiretroviral therapy, loss to follow-up and mortality among HIV-infected patients during the pre-ART period in Uganda. J Acquir Immune Defic Syndr. 2013;63(2):e64–71.CrossRefPubMedCentralPubMed
15.
Hoffmann CJ, Lewis JJ, Dowdy DW, Fielding KL, Grant AD, Martinson NA, et al. Mortality associated with delays between clinic entry and ART initiation in resource-limited settings: results of a transition-state model. J Acquir Immune Defic Syndr. 2013;63(1):105–11.CrossRefPubMedCentralPubMed
16.
Hull MW, Wu Z, Montaner JS. Optimizing the engagement of care cascade: a critical step to maximize the impact of HIV treatment as prevention. Curr Opin HIV AIDS. 2012;7(6):579–86.CrossRefPubMed
17.
Endicott P, Metspalu M, Stringer C, Macaulay V, Cooper A, Sanchez JJ. Multiplexed SNP typing of ancient DNA clarifies the origin of Andaman mtDNA haplogroups amongst South Asian tribal populations. PLoS One. 2006;1:e81.CrossRefPubMedCentralPubMed
18.
Kanters S, Nansubuga M, Mwehire D, Odiit M, Kasirye M, Musoke W, et al. Increased mortality among HIV-positive men on antiretroviral therapy: survival differences between sexes explained by late initiation in Uganda. HIV/AIDS (Auckl, NZ). 2013;5:111–9.
19.
Haines T, Stringer B. Physical exertion at work during pregnancy did not increase risk of preterm delivery or fetal growth restriction. Evid Based Med. 2006;11(5):156.CrossRefPubMed
20.
Kilmarx PH, Mutasa-Apollo T. Patching a leaky pipe: the cascade of HIV care. Curr Opin HIV AIDS. 2013;8(1):59–64.PubMed
21.
Moon TD, Burlison JR, Sidat M, et al. Lessons learned while implementing an HIV/AIDS care and treatment program in rural Mozambique. Retrovirol Res Treat. 2010;(3):1–14.
22.
Fe H. Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. New York: Springer; 2001.
23.
24.
Instituto Nacional de Estatística (INE), I.M., Inquérito Nacional de Prevalência, Riscos Comportamentais e Informação sobre o HIV e SIDA (INSIDA) em Moçambique 2009. In 2010 Calverton, Maryland, EUA: INS, INE, e ICF Macro.
25.
Miller CM, Ketlhapile M, Rybasack-Smith H, Rosen S. Why are antiretroviral treatment patients lost to follow-up? A qualitative study from South Africa. Trop Med Int Health. 2010;15(Suppl. 1):48–54.CrossRefPubMedCentralPubMed
26.
Micek MA, Gimbel-Sherr K, Baptista AJ, Matediana E, Montoya P, Pfeiffer J, et al. Loss to follow-up of adults in public HIV care systems in central Mozambique: identifying obstacles to treatment. J Acquir Immune Defic Syndr. 2009;52(3):397–405.CrossRefPubMedCentralPubMed
27.
Evans D, Menezes C, Mahomed K, Macdonald P, Untiedt S, Levin L, et al. Treatment outcomes of HIV-infected adolescents attending public-sector HIV clinics across Gauteng and Mpumalanga, South Africa. AIDS Res Hum Retrovir. 2013;29(6):892–900.CrossRefPubMedCentralPubMed
28.
Maskew M, Brennan AT, Westreich D, McNamara L, MacPhail AP, Fox MP. Gender differences in mortality and CD4 count response among virally suppressed HIV-positive patients. J Women’ Health. 2013;22(2):113–20.CrossRef
29.
Cornell M, Schomaker M, Garone DB, Giddy J, Hoffmann CJ, Lessells R, et al. Gender differences in survival among adult patients starting antiretroviral therapy in South Africa: a multicentre cohort study. PLoS Med. 2012;9(9):e1001304.CrossRefPubMedCentralPubMed
30.
Shepherd BE, Blevins M, Vaz LM, Moon TD, Kipp AM, Jose E, et al. Impact of definitions of loss to follow-up on estimates of retention, disease progression, and mortality: application to an HIV program in Mozambique. Am J Epidemiol. 2013;178(5):819–28.CrossRefPubMedCentralPubMed
31.
Charurat M, Oyegunle M, Benjamin R, Habib A, Eze E, Ele P, et al. Patient retention and adherence to antiretrovirals in a large antiretroviral therapy program in Nigeria: a longitudinal analysis for risk factors. PLoS One. 2010;5(5):e10584.CrossRefPubMedCentralPubMed
32.
Gupta A, Nadkarni G, Yang WT, Chandrasekhar A, Gupte N, Bisson GP, et al. Early mortality in adults initiating antiretroviral therapy (ART) in low- and middle-income countries (LMIC): a systematic review and meta-analysis. PLoS One. 2011;6(12):e28691.CrossRefPubMedCentralPubMed
33.
Peltzer K, Ramlagan S, Khan MS, Gaede B. The social and clinical characteristics of patients on antiretroviral therapy who are ‘lost to follow-up’ in KwaZulu-Natal, South Africa: a prospective study. SAHARA J Soc Asp HIV/AIDS Res Alliance. 2011;8(4):179–86.CrossRef
34.
McGrath N, Richter L, Newell ML. Sexual risk after HIV diagnosis: a comparison of pre-ART individuals with CD4>500 cells/microl and ART-eligible individuals in a HIV treatment and care programme in rural KwaZulu-Natal, South Africa. J Int AIDS Soc. 2013;16:18048.CrossRefPubMedCentralPubMed
35.
Hassan AS, Fielding KL, Thuo NM, Nabwera HM, Sanders EJ, Berkley JA. Early loss to follow-up of recently diagnosed HIV-infected adults from routine pre-ART care in a rural district hospital in Kenya: a cohort study. Trop Med Int Health. 2012;17(1):82–93.CrossRefPubMedCentralPubMed
36.
Fatti G, Meintjes G, Shea J, Eley B, Grimwood A. Improved survival and antiretroviral treatment outcomes in adults receiving community-based adherence support: 5-year results from a multicentre cohort study in South Africa. J Acquir Immune Defic Syndr. 2012;61(4):e50–8.CrossRefPubMed
37.
Lamb MR, El-Sadr WM, Geng E, Nash D. Association of adherence support and outreach services with total attrition, loss to follow-up, and death among ART patients in sub-Saharan Africa. PLoS One. 2012;7(6):e38443.CrossRefPubMedCentralPubMed
38.
Groh K, Audet CM, Baptista A, Sidat M, Vergara A, Vermund SH, et al. Barriers to antiretroviral therapy adherence in rural Mozambique. BMC Public Health. 2011;11:650.CrossRefPubMedCentralPubMed
Metadata
Title
Patient Loss to Follow-Up Before Antiretroviral Therapy Initiation in Rural Mozambique
Authors
Monica da Silva
Meridith Blevins
C. William Wester
José Manjolo
Eurico José
Lazaro C. Gonzalez
Bryan E. Shepherd
Troy D. Moon
Lara M. E. Vaz
Publication date
01-04-2015
Publisher
Springer US
Published in
AIDS and Behavior / Issue 4/2015
Print ISSN: 1090-7165
Electronic ISSN: 1573-3254
DOI
https://doi.org/10.1007/s10461-014-0874-0

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WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

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