Trends, treatment outcomes, and determinants for attrition among adult patients in care at a large tertiary HIV clinic in Nairobi, Kenya: a 2004–2015 retrospective cohort study

Trends, treatment outcomes, and determinants for attrition among adult patients in care at a large tertiary HIV clinic in Nairobi, Kenya: a 2004–2015 retrospective cohort study

Jared O Mecha,1 Elizabeth N Kubo,1 Lucy W Nganga,2 Peter N Muiruri,3 Lilian N Njagi,1 Syokau Ilovi,1 Richard Ngethe,2 Immaculate Mutisya,4 Evelyn W Ngugi,4 Elizabeth Maleche-Obimbo1 1Department of Clinical Medicine & Therapeutics, University of Nairobi School of Medicine, Nairobi, Kenya, 2Th...

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Autores principales: Mecha JO, Kubo EN, Nganga LW, Muiruri PN, Njagi LN, Ilovi S, Ngethe R, Mutisya I, Ngugi EW, Maleche-Obimbo E
Formato: article
Lenguaje:EN
Publicado: Dove Medical Press 2018
Materias:
HIV
Antiretroviral therapy
attrition
lost to follow up
risk factors
Kenya
Immunologic diseases. Allergy
RC581-607
Acceso en línea:https://doaj.org/article/6434b342c33741099b014e9e2488b8e0
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spelling oai:doaj.org-article:6434b342c33741099b014e9e2488b8e02021-12-02T02:03:32ZTrends, treatment outcomes, and determinants for attrition among adult patients in care at a large tertiary HIV clinic in Nairobi, Kenya: a 2004–2015 retrospective cohort study1179-1373https://doaj.org/article/6434b342c33741099b014e9e2488b8e02018-06-01T00:00:00Zhttps://www.dovepress.com/trends-treatment-outcomes-and-determinants-for-attrition-among-adult-p-peer-reviewed-article-HIVhttps://doaj.org/toc/1179-1373Jared O Mecha,1 Elizabeth N Kubo,1 Lucy W Nganga,2 Peter N Muiruri,3 Lilian N Njagi,1 Syokau Ilovi,1 Richard Ngethe,2 Immaculate Mutisya,4 Evelyn W Ngugi,4 Elizabeth Maleche-Obimbo1 1Department of Clinical Medicine & Therapeutics, University of Nairobi School of Medicine, Nairobi, Kenya, 2The Palladium Group, Nairobi, Kenya, 3Kenyatta National Hospital, Nairobi, Kenya, 4Division of Global HIV and TB (DGHT), US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya Background: Understanding trends in patient profiles and identifying predictors for adverse outcomes are key to improving the effectiveness of HIV care and treatment programs. Previous work in Kenya has documented findings from a rural setting. This paper describes trends in demographic and clinical characteristics of antiretroviral therapy (ART) treatment cohorts at a large urban, referral HIV clinic and explores treatment outcomes and factors associated with attrition during 12 years of follow-up. Methods: This was a retrospective cohort analysis of HIV-infected adults who started ART between January 1, 2004, and September 30, 2015. ART-experienced patients and those with missing data were excluded. The Cochran–Armitage test was used to determine trends in baseline characteristics over time. Cox proportional hazards models were used to determine the effect of baseline characteristics on attrition. Results: ART uptake among older adolescents (15–19 years), youth, and young adults increased over time (p=0.0001). Independent predictors for attrition included (adjusted hazard ratio [95% CI]) male sex: 1.30 (1.16–1.45), p=0.0001; age: 15–19 years: 1.83 (1.26–2.66), p=0.0014; 20–24 years: 1.93 (1.52–2.44), p=0.0001; and 25–29 years: 1.31 (1.11–1.54), p=0.0012; marital status – single: 1.27 (1.11–1.44), p=0.0005; and divorced/separated: 1.56 (1.30–1.87), p=0.0001; urban residence: 1.40 (1.20–1.64), p=0.0001; entry into HIV care following hospitalization: 1.31 (1.10–1.57), p=0.0026, or transfer from another facility: 1.60 (1.26–2.04), p=0.0001; initiation of ART more than 12 months after the date of HIV diagnosis: 1.36 (1.19–1.55), p=0.0001, and history of a current or past opportunistic infection (OI): 1.15 (1.02–1.30), p=0.0284. Conclusion: Although ART uptake among adolescents and young people increased over time, this group was at increased risk for attrition. Single marital status, urban residence, history of hospitalization or OI, and delayed initiation of ART also predicted attrition. This calls for focused evidence-informed strategies to address attrition and improve outcomes. Keywords: antiretroviral therapy, attrition, lost to follow-up, risk factors, electronic medical records, adolescents, urbanMecha JOKubo ENNganga LWMuiruri PNNjagi LNIlovi SNgethe RMutisya INgugi EWMaleche-Obimbo EDove Medical PressarticleHIVAntiretroviral therapyattritionlost to follow uprisk factorsKenyaImmunologic diseases. AllergyRC581-607ENHIV/AIDS: Research and Palliative Care, Vol Volume 10, Pp 103-114 (2018)
institution DOAJ
collection DOAJ
language EN
topic HIV
Antiretroviral therapy
attrition
lost to follow up
risk factors
Kenya
Immunologic diseases. Allergy
RC581-607
spellingShingle HIV
Antiretroviral therapy
attrition
lost to follow up
risk factors
Kenya
Immunologic diseases. Allergy
RC581-607
Mecha JO
Kubo EN
Nganga LW
Muiruri PN
Njagi LN
Ilovi S
Ngethe R
Mutisya I
Ngugi EW
Maleche-Obimbo E
Trends, treatment outcomes, and determinants for attrition among adult patients in care at a large tertiary HIV clinic in Nairobi, Kenya: a 2004–2015 retrospective cohort study
description Jared O Mecha,1 Elizabeth N Kubo,1 Lucy W Nganga,2 Peter N Muiruri,3 Lilian N Njagi,1 Syokau Ilovi,1 Richard Ngethe,2 Immaculate Mutisya,4 Evelyn W Ngugi,4 Elizabeth Maleche-Obimbo1 1Department of Clinical Medicine & Therapeutics, University of Nairobi School of Medicine, Nairobi, Kenya, 2The Palladium Group, Nairobi, Kenya, 3Kenyatta National Hospital, Nairobi, Kenya, 4Division of Global HIV and TB (DGHT), US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya Background: Understanding trends in patient profiles and identifying predictors for adverse outcomes are key to improving the effectiveness of HIV care and treatment programs. Previous work in Kenya has documented findings from a rural setting. This paper describes trends in demographic and clinical characteristics of antiretroviral therapy (ART) treatment cohorts at a large urban, referral HIV clinic and explores treatment outcomes and factors associated with attrition during 12 years of follow-up. Methods: This was a retrospective cohort analysis of HIV-infected adults who started ART between January 1, 2004, and September 30, 2015. ART-experienced patients and those with missing data were excluded. The Cochran–Armitage test was used to determine trends in baseline characteristics over time. Cox proportional hazards models were used to determine the effect of baseline characteristics on attrition. Results: ART uptake among older adolescents (15–19 years), youth, and young adults increased over time (p=0.0001). Independent predictors for attrition included (adjusted hazard ratio [95% CI]) male sex: 1.30 (1.16–1.45), p=0.0001; age: 15–19 years: 1.83 (1.26–2.66), p=0.0014; 20–24 years: 1.93 (1.52–2.44), p=0.0001; and 25–29 years: 1.31 (1.11–1.54), p=0.0012; marital status – single: 1.27 (1.11–1.44), p=0.0005; and divorced/separated: 1.56 (1.30–1.87), p=0.0001; urban residence: 1.40 (1.20–1.64), p=0.0001; entry into HIV care following hospitalization: 1.31 (1.10–1.57), p=0.0026, or transfer from another facility: 1.60 (1.26–2.04), p=0.0001; initiation of ART more than 12 months after the date of HIV diagnosis: 1.36 (1.19–1.55), p=0.0001, and history of a current or past opportunistic infection (OI): 1.15 (1.02–1.30), p=0.0284. Conclusion: Although ART uptake among adolescents and young people increased over time, this group was at increased risk for attrition. Single marital status, urban residence, history of hospitalization or OI, and delayed initiation of ART also predicted attrition. This calls for focused evidence-informed strategies to address attrition and improve outcomes. Keywords: antiretroviral therapy, attrition, lost to follow-up, risk factors, electronic medical records, adolescents, urban
format article
author Mecha JO
Kubo EN
Nganga LW
Muiruri PN
Njagi LN
Ilovi S
Ngethe R
Mutisya I
Ngugi EW
Maleche-Obimbo E
author_facet Mecha JO
Kubo EN
Nganga LW
Muiruri PN
Njagi LN
Ilovi S
Ngethe R
Mutisya I
Ngugi EW
Maleche-Obimbo E
author_sort Mecha JO
title Trends, treatment outcomes, and determinants for attrition among adult patients in care at a large tertiary HIV clinic in Nairobi, Kenya: a 2004–2015 retrospective cohort study
title_short Trends, treatment outcomes, and determinants for attrition among adult patients in care at a large tertiary HIV clinic in Nairobi, Kenya: a 2004–2015 retrospective cohort study
title_full Trends, treatment outcomes, and determinants for attrition among adult patients in care at a large tertiary HIV clinic in Nairobi, Kenya: a 2004–2015 retrospective cohort study
title_fullStr Trends, treatment outcomes, and determinants for attrition among adult patients in care at a large tertiary HIV clinic in Nairobi, Kenya: a 2004–2015 retrospective cohort study
title_full_unstemmed Trends, treatment outcomes, and determinants for attrition among adult patients in care at a large tertiary HIV clinic in Nairobi, Kenya: a 2004–2015 retrospective cohort study
title_sort trends, treatment outcomes, and determinants for attrition among adult patients in care at a large tertiary hiv clinic in nairobi, kenya: a 2004–2015 retrospective cohort study
publisher Dove Medical Press
publishDate 2018
url https://doaj.org/article/6434b342c33741099b014e9e2488b8e0
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