Effect of older age at initiation of antiretroviral therapy on patient retention in an urban ART program in Uganda

Abstract

correspondence: etheldreda Nakimuli-Mpungu Mental Health Department, Johns Hopkins Bloomberg school of Public Health, 624 N Broadway, Hampton House, Baltimore, MD 21205, UsA Tel +1 443 839 4012 Fax +1 410 955 9088 email enakimul@jhsph.edu Purpose: Patient retention in antiretroviral therapy (ART) programs in Sub-Saharan Africa is estimated at 60%. There is limited information on the effect of older age (.50 years) at ART initiation on patient retention in ART programs in Uganda. This study aimed to investigate demographic and clinical differences between older and younger human immunodeficiency virus (HIV)-positive individuals prior to ART initiation and then to assess the effect of older age at ART initiation on patient retention in an ART program. Methods: A retrospective chart review of all medical charts belonging to 773 HIV-positive individuals who initiated ART from January 2005 through July 2009 was conducted. Factors associated with older HIV-positive individuals were determined using simple and multivariate logistic regression. Survival analysis techniques were used to compare median survival times in the ART program between older and younger HIV-positive individuals. Cox regression models were used to assess the impact of older age on patient retention while adjusting for variables associated with both older age and patient retention. Results: Older HIV-positive individuals were significantly more likely to have a clinical diagnosis of HIV-related dementia (odds ratio [OR] = 7.65; P = 0.037), severe mental illness (OR = 1.28; P = 0.39), peripheral neuropathy, (OR = 3.76; P = 0.024), and HIV wasting syndrome (OR = 1.92; P = 0.023). Median survival time for older HIV-positive individuals was eight months longer than that of their younger counterparts (log-rank χ2 = 3.3, P = 0.45) Independent predictors of loss to follow-up were a clinical diagnosis of HIV-related dementia (hazards ratio [HR] = 4.63; P = 0.000), severe mental illness (HR = 1.44; P = 0.005), and HIV wasting syndrome (OR = 1.35; P = 0.008). Conclusion: There was no difference in patient retention rates between younger and older HIV-positive individuals. However, a clinical diagnosis of HIV dementia, severe mental disorder, HIV wasting syndrome, and CD4 counts less than 200 were independent predictors of low patient retention rates in this ART program.