Cargando…
Are there differences in HIV retention in care between female and male patients in Indonesia? A multi-state analysis of a retrospective cohort study
BACKGROUND: Little is known about HIV treatment outcomes in Indonesia, which has one of the most rapidly growing HIV epidemics worldwide. METHODS: We examined possible differences in loss to follow-up (LTFU) and survival between HIV-infected females and males over a 7-year period in an HIV clinic in...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592601/ https://www.ncbi.nlm.nih.gov/pubmed/31237899 http://dx.doi.org/10.1371/journal.pone.0218781 |
_version_ | 1783429916294905856 |
---|---|
author | Rahmalia, Annisa Price, Michael Holton Hartantri, Yovita Alisjahbana, Bachti Wisaksana, Rudi van Crevel, Reinout van der Ven, Andre J. A. M. |
author_facet | Rahmalia, Annisa Price, Michael Holton Hartantri, Yovita Alisjahbana, Bachti Wisaksana, Rudi van Crevel, Reinout van der Ven, Andre J. A. M. |
author_sort | Rahmalia, Annisa |
collection | PubMed |
description | BACKGROUND: Little is known about HIV treatment outcomes in Indonesia, which has one of the most rapidly growing HIV epidemics worldwide. METHODS: We examined possible differences in loss to follow-up (LTFU) and survival between HIV-infected females and males over a 7-year period in an HIV clinic in Bandung, West Java. Data imputation was performed on missing covariates and a multi-state Cox regression was used to investigate the effects of sex and other covariates on patient transitions among four states: (1) clinic enrollment with HIV, (2) initiation/continuation/re-initiation of antiretroviral therapy (ART), (3) LTFU, and (4) death. RESULTS: We followed 3215 patients (33% females), for a total of 8430 person-years. ART was used by 59% of patients at some point. One-year retention was 73% for females and 77% for males (p = 0.06). One-year survival was 98% for both females and males (p = 0.15). Females experienced a higher relative hazard to transition from HIV to LTFU (adjusted hazard ratio 1.21; 95% confidence interval 1.00–1.45), but this decreased after adjustments for clinical variables (aHR 0.94; 95% CI 0.79–1.11). Similarly, a lower relative hazard in females to transition from ART to death (aHR 0.59; 95% CI 0.35–0.99) decreased after adjustments for demographic variables. CONCLUSION: This Indonesian cohort has low ART uptake and poor overall pre- and post-ART retention. Female-male differences in survival and retention were gone after adjusting for clinical and sociodemographic factors such as CD4 count and education level. Efforts should be made to improve retention among patients with lower education. |
format | Online Article Text |
id | pubmed-6592601 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-65926012019-07-05 Are there differences in HIV retention in care between female and male patients in Indonesia? A multi-state analysis of a retrospective cohort study Rahmalia, Annisa Price, Michael Holton Hartantri, Yovita Alisjahbana, Bachti Wisaksana, Rudi van Crevel, Reinout van der Ven, Andre J. A. M. PLoS One Research Article BACKGROUND: Little is known about HIV treatment outcomes in Indonesia, which has one of the most rapidly growing HIV epidemics worldwide. METHODS: We examined possible differences in loss to follow-up (LTFU) and survival between HIV-infected females and males over a 7-year period in an HIV clinic in Bandung, West Java. Data imputation was performed on missing covariates and a multi-state Cox regression was used to investigate the effects of sex and other covariates on patient transitions among four states: (1) clinic enrollment with HIV, (2) initiation/continuation/re-initiation of antiretroviral therapy (ART), (3) LTFU, and (4) death. RESULTS: We followed 3215 patients (33% females), for a total of 8430 person-years. ART was used by 59% of patients at some point. One-year retention was 73% for females and 77% for males (p = 0.06). One-year survival was 98% for both females and males (p = 0.15). Females experienced a higher relative hazard to transition from HIV to LTFU (adjusted hazard ratio 1.21; 95% confidence interval 1.00–1.45), but this decreased after adjustments for clinical variables (aHR 0.94; 95% CI 0.79–1.11). Similarly, a lower relative hazard in females to transition from ART to death (aHR 0.59; 95% CI 0.35–0.99) decreased after adjustments for demographic variables. CONCLUSION: This Indonesian cohort has low ART uptake and poor overall pre- and post-ART retention. Female-male differences in survival and retention were gone after adjusting for clinical and sociodemographic factors such as CD4 count and education level. Efforts should be made to improve retention among patients with lower education. Public Library of Science 2019-06-25 /pmc/articles/PMC6592601/ /pubmed/31237899 http://dx.doi.org/10.1371/journal.pone.0218781 Text en © 2019 Rahmalia et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Rahmalia, Annisa Price, Michael Holton Hartantri, Yovita Alisjahbana, Bachti Wisaksana, Rudi van Crevel, Reinout van der Ven, Andre J. A. M. Are there differences in HIV retention in care between female and male patients in Indonesia? A multi-state analysis of a retrospective cohort study |
title | Are there differences in HIV retention in care between female and male patients in Indonesia? A multi-state analysis of a retrospective cohort study |
title_full | Are there differences in HIV retention in care between female and male patients in Indonesia? A multi-state analysis of a retrospective cohort study |
title_fullStr | Are there differences in HIV retention in care between female and male patients in Indonesia? A multi-state analysis of a retrospective cohort study |
title_full_unstemmed | Are there differences in HIV retention in care between female and male patients in Indonesia? A multi-state analysis of a retrospective cohort study |
title_short | Are there differences in HIV retention in care between female and male patients in Indonesia? A multi-state analysis of a retrospective cohort study |
title_sort | are there differences in hiv retention in care between female and male patients in indonesia? a multi-state analysis of a retrospective cohort study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592601/ https://www.ncbi.nlm.nih.gov/pubmed/31237899 http://dx.doi.org/10.1371/journal.pone.0218781 |
work_keys_str_mv | AT rahmaliaannisa aretheredifferencesinhivretentionincarebetweenfemaleandmalepatientsinindonesiaamultistateanalysisofaretrospectivecohortstudy AT pricemichaelholton aretheredifferencesinhivretentionincarebetweenfemaleandmalepatientsinindonesiaamultistateanalysisofaretrospectivecohortstudy AT hartantriyovita aretheredifferencesinhivretentionincarebetweenfemaleandmalepatientsinindonesiaamultistateanalysisofaretrospectivecohortstudy AT alisjahbanabachti aretheredifferencesinhivretentionincarebetweenfemaleandmalepatientsinindonesiaamultistateanalysisofaretrospectivecohortstudy AT wisaksanarudi aretheredifferencesinhivretentionincarebetweenfemaleandmalepatientsinindonesiaamultistateanalysisofaretrospectivecohortstudy AT vancrevelreinout aretheredifferencesinhivretentionincarebetweenfemaleandmalepatientsinindonesiaamultistateanalysisofaretrospectivecohortstudy AT vandervenandrejam aretheredifferencesinhivretentionincarebetweenfemaleandmalepatientsinindonesiaamultistateanalysisofaretrospectivecohortstudy |