Cargando…
Patient retention in antiretroviral therapy programs up to three years on treatment in sub-Saharan Africa, 2007–2009: systematic review
OBJECTIVES: To estimate the proportion of all-cause adult patient attrition from antiretroviral therapy (ART) programs in service delivery settings in sub-Saharan Africa through 36 months on treatment. METHODS: We identified cohorts within Ovid Medline, ISI Web of Knowledge, Cochrane Database of Sys...
Autores principales: | , |
---|---|
Formato: | Texto |
Lenguaje: | English |
Publicado: |
Blackwell Publishing Ltd
2010
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948795/ https://www.ncbi.nlm.nih.gov/pubmed/20586956 http://dx.doi.org/10.1111/j.1365-3156.2010.02508.x |
_version_ | 1782187497779888128 |
---|---|
author | Fox, Matthew P Rosen, Sydney |
author_facet | Fox, Matthew P Rosen, Sydney |
author_sort | Fox, Matthew P |
collection | PubMed |
description | OBJECTIVES: To estimate the proportion of all-cause adult patient attrition from antiretroviral therapy (ART) programs in service delivery settings in sub-Saharan Africa through 36 months on treatment. METHODS: We identified cohorts within Ovid Medline, ISI Web of Knowledge, Cochrane Database of Systematic Reviews and four conference abstract archives. We summarized retention rates from studies describing observational cohorts from sub-Saharan Africa reporting on adult HIV 1- infected patients initiating first-line three-drug ART. We estimated all-cause attrition rates for 6, 12, 18, 24, or 36 months after ART initiation including patients who died or were lost to follow-up (as defined by the author), but excluding transferred patients. RESULTS: We analysed 33 sources describing 39 cohorts and 226 307 patients. Patients were more likely to be female (median 65%) and had a median age at initiation of 37 (range 34–40). Median starting CD4 count was 109 cells/mm(3). Loss to follow-up was the most common cause of attrition (59%), followed by death (41%). Median attrition at 12, 24 and 36 months was 22.6% (range 7%–45%), 25% (range 11%–32%) and 29.5% (range 13%–36.1%) respectively. After pooling data in a random-effects meta-analysis, retention declined from 86.1% at 6 months to 80.2% at 12 months, 76.8% at 24 months and 72.3% at 36 months. Adjusting for variable follow-up time in a sensitivity analysis, 24 month retention was 70.0% (range: 66.7%–73.3%), while 36 month retention was 64.6% (range: 57.5%–72.1%). CONCLUSIONS: Our findings document the difficulties in retaining patients in care for lifelong treatment, and the progress being made in raising overall retention rates. |
format | Text |
id | pubmed-2948795 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2010 |
publisher | Blackwell Publishing Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-29487952011-03-25 Patient retention in antiretroviral therapy programs up to three years on treatment in sub-Saharan Africa, 2007–2009: systematic review Fox, Matthew P Rosen, Sydney Trop Med Int Health Part I: Rates of Retention and Reasons for Attrition OBJECTIVES: To estimate the proportion of all-cause adult patient attrition from antiretroviral therapy (ART) programs in service delivery settings in sub-Saharan Africa through 36 months on treatment. METHODS: We identified cohorts within Ovid Medline, ISI Web of Knowledge, Cochrane Database of Systematic Reviews and four conference abstract archives. We summarized retention rates from studies describing observational cohorts from sub-Saharan Africa reporting on adult HIV 1- infected patients initiating first-line three-drug ART. We estimated all-cause attrition rates for 6, 12, 18, 24, or 36 months after ART initiation including patients who died or were lost to follow-up (as defined by the author), but excluding transferred patients. RESULTS: We analysed 33 sources describing 39 cohorts and 226 307 patients. Patients were more likely to be female (median 65%) and had a median age at initiation of 37 (range 34–40). Median starting CD4 count was 109 cells/mm(3). Loss to follow-up was the most common cause of attrition (59%), followed by death (41%). Median attrition at 12, 24 and 36 months was 22.6% (range 7%–45%), 25% (range 11%–32%) and 29.5% (range 13%–36.1%) respectively. After pooling data in a random-effects meta-analysis, retention declined from 86.1% at 6 months to 80.2% at 12 months, 76.8% at 24 months and 72.3% at 36 months. Adjusting for variable follow-up time in a sensitivity analysis, 24 month retention was 70.0% (range: 66.7%–73.3%), while 36 month retention was 64.6% (range: 57.5%–72.1%). CONCLUSIONS: Our findings document the difficulties in retaining patients in care for lifelong treatment, and the progress being made in raising overall retention rates. Blackwell Publishing Ltd 2010-06 /pmc/articles/PMC2948795/ /pubmed/20586956 http://dx.doi.org/10.1111/j.1365-3156.2010.02508.x Text en © 2010 Blackwell Publishing Ltd http://creativecommons.org/licenses/by/2.5/ Re-use of this article is permitted in accordance with the Creative Commons Deed, Attribution 2.5, which does not permit commercial exploitation. |
spellingShingle | Part I: Rates of Retention and Reasons for Attrition Fox, Matthew P Rosen, Sydney Patient retention in antiretroviral therapy programs up to three years on treatment in sub-Saharan Africa, 2007–2009: systematic review |
title | Patient retention in antiretroviral therapy programs up to three years on treatment in sub-Saharan Africa, 2007–2009: systematic review |
title_full | Patient retention in antiretroviral therapy programs up to three years on treatment in sub-Saharan Africa, 2007–2009: systematic review |
title_fullStr | Patient retention in antiretroviral therapy programs up to three years on treatment in sub-Saharan Africa, 2007–2009: systematic review |
title_full_unstemmed | Patient retention in antiretroviral therapy programs up to three years on treatment in sub-Saharan Africa, 2007–2009: systematic review |
title_short | Patient retention in antiretroviral therapy programs up to three years on treatment in sub-Saharan Africa, 2007–2009: systematic review |
title_sort | patient retention in antiretroviral therapy programs up to three years on treatment in sub-saharan africa, 2007–2009: systematic review |
topic | Part I: Rates of Retention and Reasons for Attrition |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948795/ https://www.ncbi.nlm.nih.gov/pubmed/20586956 http://dx.doi.org/10.1111/j.1365-3156.2010.02508.x |
work_keys_str_mv | AT foxmatthewp patientretentioninantiretroviraltherapyprogramsuptothreeyearsontreatmentinsubsaharanafrica20072009systematicreview AT rosensydney patientretentioninantiretroviraltherapyprogramsuptothreeyearsontreatmentinsubsaharanafrica20072009systematicreview |