Cargando…
Factors associated with 36-month loss to follow-up and mortality outcomes among HIV-infected adults on antiretroviral therapy in Central Kenya
BACKGROUND: The scale-up of HIV treatment programs has resulted in a reduction in HIV-related morbidity and mortality. However, retention of patients in these programs remains a challenge in sub-Saharan Africa. Understanding factors associated with loss to follow-up (LTFU) and mortality outcomes is...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071670/ https://www.ncbi.nlm.nih.gov/pubmed/32171279 http://dx.doi.org/10.1186/s12889-020-8426-1 |
_version_ | 1783506255173648384 |
---|---|
author | Wekesa, Paul McLigeyo, Angela Owuor, Kevin Mwangi, Jonathan Nganga, Evelyne Masamaro, Kenneth |
author_facet | Wekesa, Paul McLigeyo, Angela Owuor, Kevin Mwangi, Jonathan Nganga, Evelyne Masamaro, Kenneth |
author_sort | Wekesa, Paul |
collection | PubMed |
description | BACKGROUND: The scale-up of HIV treatment programs has resulted in a reduction in HIV-related morbidity and mortality. However, retention of patients in these programs remains a challenge in sub-Saharan Africa. Understanding factors associated with loss to follow-up (LTFU) and mortality outcomes is therefore important to inform targeted program interventions. METHODS: A retrospective multi-cohort analysis of 23,890 adult patients on ART over 36 months of follow-up in Kenya was done. Multivariate logistic regression analysis was done to assess for factors associated with LTFU and mortality at 6, 12, 24, and 36 months of follow-up. RESULTS: Majority, 67.7%, were female. At 36 months, 27.2% were LTFU and 13.5% had died. Factors associated with mortality at 36 months included older age (51 years and above) using 20–35 years as reference [(adjusted odds ratio [aOR], 1.51, 95% confidence interval (CI) 1.23–1.86, p < 0.001], being male (aOR, 1.59, 95% CI 1.39–1.83, p < 0.001), divorced using married as reference (aOR, 1.86, 95% CI 1.56–2.22, p < 0.001), having a body mass index (BMI) score of less than 18.5 kg/m(2) using 18.5–24.9 kg/m(2) as reference (aOR = 1.79, 95% CI 1.52–2.11, p < 0.001), and, World Health Organization stage III and IV using stage I as the reference (aOR, 1.94, 95% CI 1.43–2.63 and aOR, 4.24, 95% CI 3.06–5.87, p < 0.001 respectively). Factors associated with LTFU at 36 months included being young between 20 and 35 years (aOR, 1.49, 95% CI 1.40–1.59, p < 0.001) using 36–50 years as reference, being male (aOR, 1.19, 95% CI 1.12–1.27, p < 0.001), and being single or divorced using married as reference (aOR, 1.34, 95% CI 1.23–1.45 and aOR, 1.25, 95% CI 1.15–1.36, p < 0.001 respectively). Patients with baseline BMI of less than 18.5 kg/m(2) using normal BMI as reference (aOR, 1.68, 95% CI 1.39–2.02, p < 0.001) were also likely to be LTFU. CONCLUSIONS: Factors associated with LTFU and mortality were generally similar over time. Implementation of programs in similar settings should be tailored to gender, age profiles, nutritional, and, marital status of patients to address LTFU. In addition, programs should focus on the care of older patients to reduce the risk of mortality. |
format | Online Article Text |
id | pubmed-7071670 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-70716702020-03-18 Factors associated with 36-month loss to follow-up and mortality outcomes among HIV-infected adults on antiretroviral therapy in Central Kenya Wekesa, Paul McLigeyo, Angela Owuor, Kevin Mwangi, Jonathan Nganga, Evelyne Masamaro, Kenneth BMC Public Health Research Article BACKGROUND: The scale-up of HIV treatment programs has resulted in a reduction in HIV-related morbidity and mortality. However, retention of patients in these programs remains a challenge in sub-Saharan Africa. Understanding factors associated with loss to follow-up (LTFU) and mortality outcomes is therefore important to inform targeted program interventions. METHODS: A retrospective multi-cohort analysis of 23,890 adult patients on ART over 36 months of follow-up in Kenya was done. Multivariate logistic regression analysis was done to assess for factors associated with LTFU and mortality at 6, 12, 24, and 36 months of follow-up. RESULTS: Majority, 67.7%, were female. At 36 months, 27.2% were LTFU and 13.5% had died. Factors associated with mortality at 36 months included older age (51 years and above) using 20–35 years as reference [(adjusted odds ratio [aOR], 1.51, 95% confidence interval (CI) 1.23–1.86, p < 0.001], being male (aOR, 1.59, 95% CI 1.39–1.83, p < 0.001), divorced using married as reference (aOR, 1.86, 95% CI 1.56–2.22, p < 0.001), having a body mass index (BMI) score of less than 18.5 kg/m(2) using 18.5–24.9 kg/m(2) as reference (aOR = 1.79, 95% CI 1.52–2.11, p < 0.001), and, World Health Organization stage III and IV using stage I as the reference (aOR, 1.94, 95% CI 1.43–2.63 and aOR, 4.24, 95% CI 3.06–5.87, p < 0.001 respectively). Factors associated with LTFU at 36 months included being young between 20 and 35 years (aOR, 1.49, 95% CI 1.40–1.59, p < 0.001) using 36–50 years as reference, being male (aOR, 1.19, 95% CI 1.12–1.27, p < 0.001), and being single or divorced using married as reference (aOR, 1.34, 95% CI 1.23–1.45 and aOR, 1.25, 95% CI 1.15–1.36, p < 0.001 respectively). Patients with baseline BMI of less than 18.5 kg/m(2) using normal BMI as reference (aOR, 1.68, 95% CI 1.39–2.02, p < 0.001) were also likely to be LTFU. CONCLUSIONS: Factors associated with LTFU and mortality were generally similar over time. Implementation of programs in similar settings should be tailored to gender, age profiles, nutritional, and, marital status of patients to address LTFU. In addition, programs should focus on the care of older patients to reduce the risk of mortality. BioMed Central 2020-03-14 /pmc/articles/PMC7071670/ /pubmed/32171279 http://dx.doi.org/10.1186/s12889-020-8426-1 Text en © The Author(s). 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Wekesa, Paul McLigeyo, Angela Owuor, Kevin Mwangi, Jonathan Nganga, Evelyne Masamaro, Kenneth Factors associated with 36-month loss to follow-up and mortality outcomes among HIV-infected adults on antiretroviral therapy in Central Kenya |
title | Factors associated with 36-month loss to follow-up and mortality outcomes among HIV-infected adults on antiretroviral therapy in Central Kenya |
title_full | Factors associated with 36-month loss to follow-up and mortality outcomes among HIV-infected adults on antiretroviral therapy in Central Kenya |
title_fullStr | Factors associated with 36-month loss to follow-up and mortality outcomes among HIV-infected adults on antiretroviral therapy in Central Kenya |
title_full_unstemmed | Factors associated with 36-month loss to follow-up and mortality outcomes among HIV-infected adults on antiretroviral therapy in Central Kenya |
title_short | Factors associated with 36-month loss to follow-up and mortality outcomes among HIV-infected adults on antiretroviral therapy in Central Kenya |
title_sort | factors associated with 36-month loss to follow-up and mortality outcomes among hiv-infected adults on antiretroviral therapy in central kenya |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071670/ https://www.ncbi.nlm.nih.gov/pubmed/32171279 http://dx.doi.org/10.1186/s12889-020-8426-1 |
work_keys_str_mv | AT wekesapaul factorsassociatedwith36monthlosstofollowupandmortalityoutcomesamonghivinfectedadultsonantiretroviraltherapyincentralkenya AT mcligeyoangela factorsassociatedwith36monthlosstofollowupandmortalityoutcomesamonghivinfectedadultsonantiretroviraltherapyincentralkenya AT owuorkevin factorsassociatedwith36monthlosstofollowupandmortalityoutcomesamonghivinfectedadultsonantiretroviraltherapyincentralkenya AT mwangijonathan factorsassociatedwith36monthlosstofollowupandmortalityoutcomesamonghivinfectedadultsonantiretroviraltherapyincentralkenya AT ngangaevelyne factorsassociatedwith36monthlosstofollowupandmortalityoutcomesamonghivinfectedadultsonantiretroviraltherapyincentralkenya AT masamarokenneth factorsassociatedwith36monthlosstofollowupandmortalityoutcomesamonghivinfectedadultsonantiretroviraltherapyincentralkenya |