Patients present earlier and survival has improved, but pre-ART attrition is high in a six-year HIV cohort data from Ethiopia.

<h4>Background</h4>Previous studies showed higher early mortality rates among patients treated with antiretroviral drugs in settings with limited resources. One of the reasons was late presentation of patients to care. With improved access to HIV services, we expect improvements in disea...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Zewdie Mulissa, Degu Jerene, Bernt Lindtjørn
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2010
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/5349135d85d14da888d3fa2fa1e34cfa
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:5349135d85d14da888d3fa2fa1e34cfa
record_format	dspace
spelling	oai:doaj.org-article:5349135d85d14da888d3fa2fa1e34cfa2021-11-18T07:03:29ZPatients present earlier and survival has improved, but pre-ART attrition is high in a six-year HIV cohort data from Ethiopia.1932-620310.1371/journal.pone.0013268https://doaj.org/article/5349135d85d14da888d3fa2fa1e34cfa2010-10-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/20949010/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Previous studies showed higher early mortality rates among patients treated with antiretroviral drugs in settings with limited resources. One of the reasons was late presentation of patients to care. With improved access to HIV services, we expect improvements in disease stage at presentation. Our objective was to assess the effect of improved availability of HIV services on patient presentation to care and subsequent pre-ART and on-ART outcomes.<h4>Methodology and principal findings</h4>At Arba Minch Hospital in Ethiopia, we reviewed baseline characteristics and outcomes of 2191 adult HIV patients. Nearly a half were in WHO stage III at presentation. About two-thirds of the patients (1428) started ART. Patients enrolled in the early phase (OR = 4.03, 95% CI 3.07-5.27), men (OR = 1.78, 95%CI 1.47-2.16), and those aged 45 years and above (OR = 2.04, 95%CI 1.48-2.82) were at higher risk of being in advanced clinical stage at presentation. The pre-treatment mortality rate was 13.1 per 100 PYO, ranging from 1.4 in the rapid scale-up phase to 25.9 per 100 PYO in the early phase. A quarter of the patients were lost to follow-up before starting treatment. Being in less advanced stage (HR = 1.9, 95% CI = 1.6, 2.2), being in the recent cohort (HR = 2.0, 95% CI = 1.6, 2.6), and rural residence (HR = 1.8, 95% CI = 1.5, 2.2) were independent predictors of pre-ART loss to follow-up. Of those who started ART, 13.4% were lost to follow-up and 15.4% died. The survival improved during the study. Patients with advanced disease, men and older people had higher death rates.<h4>Conclusions and significance</h4>Patients started to present at earlier stages of their illness and death has decreased among adult HIV patients visiting Arba Minch Hospital. However, many patients were lost from pre-treatment follow-up. Early treatment start contributed to improved survival. Both pre-ART and on-ART patient retention mechanisms should be strengthened.Zewdie MulissaDegu JereneBernt LindtjørnPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 5, Iss 10, p e13268 (2010)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Zewdie Mulissa Degu Jerene Bernt Lindtjørn Patients present earlier and survival has improved, but pre-ART attrition is high in a six-year HIV cohort data from Ethiopia.
description	<h4>Background</h4>Previous studies showed higher early mortality rates among patients treated with antiretroviral drugs in settings with limited resources. One of the reasons was late presentation of patients to care. With improved access to HIV services, we expect improvements in disease stage at presentation. Our objective was to assess the effect of improved availability of HIV services on patient presentation to care and subsequent pre-ART and on-ART outcomes.<h4>Methodology and principal findings</h4>At Arba Minch Hospital in Ethiopia, we reviewed baseline characteristics and outcomes of 2191 adult HIV patients. Nearly a half were in WHO stage III at presentation. About two-thirds of the patients (1428) started ART. Patients enrolled in the early phase (OR = 4.03, 95% CI 3.07-5.27), men (OR = 1.78, 95%CI 1.47-2.16), and those aged 45 years and above (OR = 2.04, 95%CI 1.48-2.82) were at higher risk of being in advanced clinical stage at presentation. The pre-treatment mortality rate was 13.1 per 100 PYO, ranging from 1.4 in the rapid scale-up phase to 25.9 per 100 PYO in the early phase. A quarter of the patients were lost to follow-up before starting treatment. Being in less advanced stage (HR = 1.9, 95% CI = 1.6, 2.2), being in the recent cohort (HR = 2.0, 95% CI = 1.6, 2.6), and rural residence (HR = 1.8, 95% CI = 1.5, 2.2) were independent predictors of pre-ART loss to follow-up. Of those who started ART, 13.4% were lost to follow-up and 15.4% died. The survival improved during the study. Patients with advanced disease, men and older people had higher death rates.<h4>Conclusions and significance</h4>Patients started to present at earlier stages of their illness and death has decreased among adult HIV patients visiting Arba Minch Hospital. However, many patients were lost from pre-treatment follow-up. Early treatment start contributed to improved survival. Both pre-ART and on-ART patient retention mechanisms should be strengthened.
format	article
author	Zewdie Mulissa Degu Jerene Bernt Lindtjørn
author_facet	Zewdie Mulissa Degu Jerene Bernt Lindtjørn
author_sort	Zewdie Mulissa
title	Patients present earlier and survival has improved, but pre-ART attrition is high in a six-year HIV cohort data from Ethiopia.
title_short	Patients present earlier and survival has improved, but pre-ART attrition is high in a six-year HIV cohort data from Ethiopia.
title_full	Patients present earlier and survival has improved, but pre-ART attrition is high in a six-year HIV cohort data from Ethiopia.
title_fullStr	Patients present earlier and survival has improved, but pre-ART attrition is high in a six-year HIV cohort data from Ethiopia.
title_full_unstemmed	Patients present earlier and survival has improved, but pre-ART attrition is high in a six-year HIV cohort data from Ethiopia.
title_sort	patients present earlier and survival has improved, but pre-art attrition is high in a six-year hiv cohort data from ethiopia.
publisher	Public Library of Science (PLoS)
publishDate	2010
url	https://doaj.org/article/5349135d85d14da888d3fa2fa1e34cfa
work_keys_str_mv	AT zewdiemulissa patientspresentearlierandsurvivalhasimprovedbutpreartattritionishighinasixyearhivcohortdatafromethiopia AT degujerene patientspresentearlierandsurvivalhasimprovedbutpreartattritionishighinasixyearhivcohortdatafromethiopia AT berntlindtjørn patientspresentearlierandsurvivalhasimprovedbutpreartattritionishighinasixyearhivcohortdatafromethiopia
_version_	1718423976717320192

Patients present earlier and survival has improved, but pre-ART attrition is high in a six-year HIV cohort data from Ethiopia.

Ejemplares similares