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Poor follow-up rates at a self-pay northern Indian tertiary AIDS clinic

BACKGROUND: In many developing countries, out-of-pocket payment remains a primary mechanism by which patients infected with HIV access treatment. In India, this has been changing as the National AIDS Control Organization (NACO) has been rolling out free antiretroviral therapy throughout the country...

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Autores principales: Maru, Duncan Smith-Rohrberg, Khakha, Deepika C, Tahir, Mohammad, Basu, Sanjay, Sharma, Surendra K
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2007
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2200646/
https://www.ncbi.nlm.nih.gov/pubmed/17958898
http://dx.doi.org/10.1186/1475-9276-6-14
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author Maru, Duncan Smith-Rohrberg
Khakha, Deepika C
Tahir, Mohammad
Basu, Sanjay
Sharma, Surendra K
author_facet Maru, Duncan Smith-Rohrberg
Khakha, Deepika C
Tahir, Mohammad
Basu, Sanjay
Sharma, Surendra K
author_sort Maru, Duncan Smith-Rohrberg
collection PubMed
description BACKGROUND: In many developing countries, out-of-pocket payment remains a primary mechanism by which patients infected with HIV access treatment. In India, this has been changing as the National AIDS Control Organization (NACO) has been rolling out free antiretroviral therapy throughout the country since 2004. The vast majority of patients, however, remain without access to free medicines. METHODS: A retrospective chart review was performed on data obtained from a registry of ninety-three (93) patients attending a self-pay clinic at the All India Institute of Medical Sciences in Delhi, India. Multivariable Cox proportional hazard and logistic regression models were explored to assess the relationship between lost-to-follow-up status and the predictor variables: age, sex, household income, baseline CD4 count, and distance from clinic. RESULTS: Lost-to-follow-up rates were very high; 68% (63/93) were lost-to-follow-up till the time of chart review, including 59% (55/93) who were lost within one year. In both regression models, younger age, low baseline CD4 counts, and low income level were significantly associated with increased risk of lost-to-follow-up. Additionally, there was a significant interaction between income and CD4 counts. The patients with both low CD4 counts and low income level were more likely to be lost-to-follow-up than would be predicted by each covariable alone. CONCLUSION: In this small cohort of AIDS patients attending a self-pay antiretroviral clinic at a large tertiary care center in Delhi, India, follow-up rates were quite poor. Poorer patients tended to present to clinic with more depressed CD4 counts and were less likely to be retained in care. These findings indicate that greater strides must be taken to improve the recruitment and retention of poor patients. The expansion of free antiretrovirals is one step among many necessary to achieve this objective.
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spelling pubmed-22006462008-01-16 Poor follow-up rates at a self-pay northern Indian tertiary AIDS clinic Maru, Duncan Smith-Rohrberg Khakha, Deepika C Tahir, Mohammad Basu, Sanjay Sharma, Surendra K Int J Equity Health Commentary BACKGROUND: In many developing countries, out-of-pocket payment remains a primary mechanism by which patients infected with HIV access treatment. In India, this has been changing as the National AIDS Control Organization (NACO) has been rolling out free antiretroviral therapy throughout the country since 2004. The vast majority of patients, however, remain without access to free medicines. METHODS: A retrospective chart review was performed on data obtained from a registry of ninety-three (93) patients attending a self-pay clinic at the All India Institute of Medical Sciences in Delhi, India. Multivariable Cox proportional hazard and logistic regression models were explored to assess the relationship between lost-to-follow-up status and the predictor variables: age, sex, household income, baseline CD4 count, and distance from clinic. RESULTS: Lost-to-follow-up rates were very high; 68% (63/93) were lost-to-follow-up till the time of chart review, including 59% (55/93) who were lost within one year. In both regression models, younger age, low baseline CD4 counts, and low income level were significantly associated with increased risk of lost-to-follow-up. Additionally, there was a significant interaction between income and CD4 counts. The patients with both low CD4 counts and low income level were more likely to be lost-to-follow-up than would be predicted by each covariable alone. CONCLUSION: In this small cohort of AIDS patients attending a self-pay antiretroviral clinic at a large tertiary care center in Delhi, India, follow-up rates were quite poor. Poorer patients tended to present to clinic with more depressed CD4 counts and were less likely to be retained in care. These findings indicate that greater strides must be taken to improve the recruitment and retention of poor patients. The expansion of free antiretrovirals is one step among many necessary to achieve this objective. BioMed Central 2007-10-24 /pmc/articles/PMC2200646/ /pubmed/17958898 http://dx.doi.org/10.1186/1475-9276-6-14 Text en Copyright © 2007 Maru et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( (http://creativecommons.org/licenses/by/2.0) ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Commentary
Maru, Duncan Smith-Rohrberg
Khakha, Deepika C
Tahir, Mohammad
Basu, Sanjay
Sharma, Surendra K
Poor follow-up rates at a self-pay northern Indian tertiary AIDS clinic
title Poor follow-up rates at a self-pay northern Indian tertiary AIDS clinic
title_full Poor follow-up rates at a self-pay northern Indian tertiary AIDS clinic
title_fullStr Poor follow-up rates at a self-pay northern Indian tertiary AIDS clinic
title_full_unstemmed Poor follow-up rates at a self-pay northern Indian tertiary AIDS clinic
title_short Poor follow-up rates at a self-pay northern Indian tertiary AIDS clinic
title_sort poor follow-up rates at a self-pay northern indian tertiary aids clinic
topic Commentary
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2200646/
https://www.ncbi.nlm.nih.gov/pubmed/17958898
http://dx.doi.org/10.1186/1475-9276-6-14
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