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Outcomes of patients on second‐ and third‐line ART enrolled in ART adherence clubs in Maputo, Mozambique

OBJECTIVES: Adherence clubs (AC) offer patient‐centred access to antiretroviral therapy (ART) while reducing the burden on health facilities. AC were implemented in a health centre in Mozambique specialising in patients with a history of HIV treatment failure. We explored the impact of AC on retenti...

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Autores principales: Finci, I., Flores, A., Gutierrez Zamudio, A. G., Matsinhe, A., de Abreu, E., Issufo, S., Gaspar, I., Ciglenecki, I., Molfino, L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756444/
https://www.ncbi.nlm.nih.gov/pubmed/32959934
http://dx.doi.org/10.1111/tmi.13490
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author Finci, I.
Flores, A.
Gutierrez Zamudio, A. G.
Matsinhe, A.
de Abreu, E.
Issufo, S.
Gaspar, I.
Ciglenecki, I.
Molfino, L.
author_facet Finci, I.
Flores, A.
Gutierrez Zamudio, A. G.
Matsinhe, A.
de Abreu, E.
Issufo, S.
Gaspar, I.
Ciglenecki, I.
Molfino, L.
author_sort Finci, I.
collection PubMed
description OBJECTIVES: Adherence clubs (AC) offer patient‐centred access to antiretroviral therapy (ART) while reducing the burden on health facilities. AC were implemented in a health centre in Mozambique specialising in patients with a history of HIV treatment failure. We explored the impact of AC on retention in care and VL suppression of these patients. METHODS: We performed a retrospective analysis of patients enrolled in AC receiving second‐ or third‐line ART. The Kaplan–Meier estimates were used to analyse retention in care in health facility, retention in AC and viral load (VL) suppression (VL < 1000 copies/mL). Predictors of attrition and VL rebound (VL ≥ 1000 copies/mL) were assessed using multivariable proportional hazards regression. RESULTS: The analysed cohort contained 699 patients, median age 40 years [IQR: 35–47], 428 (61%) female and 97% second‐line ART. Overall, 9 (1.3%) patients died, and 10 (1.4%) were lost to follow‐up. Retention in care at months 12 and 24 was 98.9% (95% CI: 98.2–99.7) and 96.4% (95% CI: 94.6–98.2), respectively. Concurrently, 85.8% (95% CI: 83.1–88.2) and 80.9% (95% CI: 77.8–84.1) of patients maintained VL suppression. No association between predictors and all‐cause attrition or VL rebound was detected. Among 90 patients attending AC and simultaneously having VL rebound, 64 (71.1%) achieved VL resuppression, 10 (11.1%) did not resuppress, and 14 (15.6%) had no subsequent VL result. CONCLUSION: Implementation of AC in Mozambique was successful and demonstrated that patients with a history of HIV treatment failure can be successfully retained in care and have high VL suppression rate when enrolled in AC. Expansion of the AC model in Mozambique could improve overall retention in care and VL suppression while reducing workload in health facilities.
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spelling pubmed-77564442020-12-28 Outcomes of patients on second‐ and third‐line ART enrolled in ART adherence clubs in Maputo, Mozambique Finci, I. Flores, A. Gutierrez Zamudio, A. G. Matsinhe, A. de Abreu, E. Issufo, S. Gaspar, I. Ciglenecki, I. Molfino, L. Trop Med Int Health Original Research Papers OBJECTIVES: Adherence clubs (AC) offer patient‐centred access to antiretroviral therapy (ART) while reducing the burden on health facilities. AC were implemented in a health centre in Mozambique specialising in patients with a history of HIV treatment failure. We explored the impact of AC on retention in care and VL suppression of these patients. METHODS: We performed a retrospective analysis of patients enrolled in AC receiving second‐ or third‐line ART. The Kaplan–Meier estimates were used to analyse retention in care in health facility, retention in AC and viral load (VL) suppression (VL < 1000 copies/mL). Predictors of attrition and VL rebound (VL ≥ 1000 copies/mL) were assessed using multivariable proportional hazards regression. RESULTS: The analysed cohort contained 699 patients, median age 40 years [IQR: 35–47], 428 (61%) female and 97% second‐line ART. Overall, 9 (1.3%) patients died, and 10 (1.4%) were lost to follow‐up. Retention in care at months 12 and 24 was 98.9% (95% CI: 98.2–99.7) and 96.4% (95% CI: 94.6–98.2), respectively. Concurrently, 85.8% (95% CI: 83.1–88.2) and 80.9% (95% CI: 77.8–84.1) of patients maintained VL suppression. No association between predictors and all‐cause attrition or VL rebound was detected. Among 90 patients attending AC and simultaneously having VL rebound, 64 (71.1%) achieved VL resuppression, 10 (11.1%) did not resuppress, and 14 (15.6%) had no subsequent VL result. CONCLUSION: Implementation of AC in Mozambique was successful and demonstrated that patients with a history of HIV treatment failure can be successfully retained in care and have high VL suppression rate when enrolled in AC. Expansion of the AC model in Mozambique could improve overall retention in care and VL suppression while reducing workload in health facilities. John Wiley and Sons Inc. 2020-10-14 2020-12 /pmc/articles/PMC7756444/ /pubmed/32959934 http://dx.doi.org/10.1111/tmi.13490 Text en © 2020 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research Papers
Finci, I.
Flores, A.
Gutierrez Zamudio, A. G.
Matsinhe, A.
de Abreu, E.
Issufo, S.
Gaspar, I.
Ciglenecki, I.
Molfino, L.
Outcomes of patients on second‐ and third‐line ART enrolled in ART adherence clubs in Maputo, Mozambique
title Outcomes of patients on second‐ and third‐line ART enrolled in ART adherence clubs in Maputo, Mozambique
title_full Outcomes of patients on second‐ and third‐line ART enrolled in ART adherence clubs in Maputo, Mozambique
title_fullStr Outcomes of patients on second‐ and third‐line ART enrolled in ART adherence clubs in Maputo, Mozambique
title_full_unstemmed Outcomes of patients on second‐ and third‐line ART enrolled in ART adherence clubs in Maputo, Mozambique
title_short Outcomes of patients on second‐ and third‐line ART enrolled in ART adherence clubs in Maputo, Mozambique
title_sort outcomes of patients on second‐ and third‐line art enrolled in art adherence clubs in maputo, mozambique
topic Original Research Papers
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7756444/
https://www.ncbi.nlm.nih.gov/pubmed/32959934
http://dx.doi.org/10.1111/tmi.13490
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