Abstract
BackgroundUnplanned care interruption (UCI) challenges effective HIV treatment. We determined the frequency and risk factors for UCI in Nigeria.MethodsWe conducted a retrospective-cohort study of adults initiating antiretroviral therapy (ART) between January 2009 and December 2011. At censor, patients were defined as in care, UCI, or inactive. Associations between baseline factors and UCI rates were quantified using Poisson regression.ResultsAmong 2,496 patients, 44 % remained in care, 35 % had ≥1 UCI, and 21 % became inactive. UCI rates were higher in the first year on ART (39/100PY), than the second (19/100PY), third (16/100PY), and fourth (14/100PY) years (p < 0.001). In multivariate analysis, baseline CD4 > 350/uL (IRR 3.21, p < 0.0001), being a student (IRR 1.95, p < 0.0001), and less education (IRR 1.58, p = 0.001) increased risk for UCI. Fifty-five percent of patients with UCI and viral load data had HIV viral load > 1,000 copies/ml upon return to care.DiscussionUCI were observed in over one-third of patients treated, and were most common in the first year on ART. High baseline CD4 count at ART initiation was the greatest predictor of subsequent UCI.ConclusionsInterventions focused on the first year on ART are needed to improve continuity of HIV care.
Highlights
Unplanned care interruption (UCI) challenges effective HIV treatment
Interventions focused on the first year on antiretroviral therapy (ART) are needed to improve continuity of HIV care
We focused the analysis on predictors of UCI in the first year on ART since other studies have linked early missed visits to mortality, and to ensure consistent follow-up time for all patients in the analysis
Summary
Unplanned care interruption (UCI) challenges effective HIV treatment. We determined the frequency and risk factors for UCI in Nigeria. HIV is a treatable, chronic disease with the availability of potent ART [1]. Retention in care over time has plagued HIV treatment programs worldwide, those in resource-limited settings (RLS) [3,4,5]. Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA. Full list of author information is available at the end of the article rates of patient loss to follow-up (LTFU) in RLS, approaching 70 % prior to ART initiation and 25-40 %. After ART initiation [5, 6] Because many of these patients (15-90 %) are later found to have died, LTFU has been equated with disengagement from the entire package of HIV care [6,7,8,9]
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