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Disparities in HIV Clinical Stages Progression of Patients at Outpatient Clinics in Democratic Republic of Congo

Context: In this era of patient-centered care, it is increasingly important for HIV/AIDS care and treatment programs to customize their services according to patients’ clinical stage progression and other risk assessments. To enable such customization of HIV care and treatment delivery, the research...

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Autores principales: Ewetola, Raimi, Shah, Gulzar H., Maluantesa, Lievain, Etheredge, Gina, Waterfield, Kristie, Mulenga, Astrid, Kilundu, Apolinaire
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8156374/
https://www.ncbi.nlm.nih.gov/pubmed/34067847
http://dx.doi.org/10.3390/ijerph18105341
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author Ewetola, Raimi
Shah, Gulzar H.
Maluantesa, Lievain
Etheredge, Gina
Waterfield, Kristie
Mulenga, Astrid
Kilundu, Apolinaire
author_facet Ewetola, Raimi
Shah, Gulzar H.
Maluantesa, Lievain
Etheredge, Gina
Waterfield, Kristie
Mulenga, Astrid
Kilundu, Apolinaire
author_sort Ewetola, Raimi
collection PubMed
description Context: In this era of patient-centered care, it is increasingly important for HIV/AIDS care and treatment programs to customize their services according to patients’ clinical stage progression and other risk assessments. To enable such customization of HIV care and treatment delivery, the research evidence explaining factors associated with patients’ clinical stages is needed. Objectives: The primary objective of this study was to produce such scientific evidence by analyzing the most recent data for patients at outpatient clinics in the provinces of Kinshasa and Haut-Katanga and to examine the patient characteristics associated with WHO stages of disease progression. Methods: Using a quantitative retrospective cohort study design, we analyzed data from 49,460 people living with HIV (PLHIV) on antiretroviral therapy (ART) from 241 HIV/AIDS clinics located in Haut-Katanga and Kinshasa provinces of the Democratic Republic of Congo. We performed Chi-square and multinomial logistic regression analyses. Results: A small proportion (i.e., 4.4%) of PLHIV were at WHO’s clinical progression stage 4, whereas 30.7% were at clinical stage 3, another 22.9% at stage 2, and the remaining 41.9% were at stage 1, the least severe stage. After controlling for other demographic and clinical factors included in the model, the likelihood of being at stage 1 rather than stage 3 or 4 was significantly higher (at p ≤ 0.05) for patients with no tuberculosis (TB) than those with TB co-infection (adjusted odds ratio or AOR, 5.73; confidence interval or CI, 4.98–6.59). The odds of being at stage 1 were significantly higher for female patients (AOR, 1.35; CI, 1.29–1.42), and those with the shorter duration on ART (vs. greater than 40.37 months). Patents in rural health zones (AOR, 0.32) and semi-rural health zones (AOR, 0.79) were less likely to be at stage 1, compared to patients in urban health zones. Conclusions: Our study showed that TB co-infection raised the risk for PLHIV to be at the severe stages of clinical progression of HIV. Such variation supports the thesis that customized HIV management approaches and clinical regimens may be imperative for this high-risk population. We also found significant variation in HIV clinical progression stages by geographic location and demographic characteristics. Such variation points to the need for more targeted efforts to address the disparities, as the programs attempt to improve the effectiveness of HIV care and treatment. The intersectionality of vulnerabilities from HIV, TB, and COVID-19-related hardships has elevated the need for customized care and treatment even more in the COVID-19 era.
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spelling pubmed-81563742021-05-28 Disparities in HIV Clinical Stages Progression of Patients at Outpatient Clinics in Democratic Republic of Congo Ewetola, Raimi Shah, Gulzar H. Maluantesa, Lievain Etheredge, Gina Waterfield, Kristie Mulenga, Astrid Kilundu, Apolinaire Int J Environ Res Public Health Article Context: In this era of patient-centered care, it is increasingly important for HIV/AIDS care and treatment programs to customize their services according to patients’ clinical stage progression and other risk assessments. To enable such customization of HIV care and treatment delivery, the research evidence explaining factors associated with patients’ clinical stages is needed. Objectives: The primary objective of this study was to produce such scientific evidence by analyzing the most recent data for patients at outpatient clinics in the provinces of Kinshasa and Haut-Katanga and to examine the patient characteristics associated with WHO stages of disease progression. Methods: Using a quantitative retrospective cohort study design, we analyzed data from 49,460 people living with HIV (PLHIV) on antiretroviral therapy (ART) from 241 HIV/AIDS clinics located in Haut-Katanga and Kinshasa provinces of the Democratic Republic of Congo. We performed Chi-square and multinomial logistic regression analyses. Results: A small proportion (i.e., 4.4%) of PLHIV were at WHO’s clinical progression stage 4, whereas 30.7% were at clinical stage 3, another 22.9% at stage 2, and the remaining 41.9% were at stage 1, the least severe stage. After controlling for other demographic and clinical factors included in the model, the likelihood of being at stage 1 rather than stage 3 or 4 was significantly higher (at p ≤ 0.05) for patients with no tuberculosis (TB) than those with TB co-infection (adjusted odds ratio or AOR, 5.73; confidence interval or CI, 4.98–6.59). The odds of being at stage 1 were significantly higher for female patients (AOR, 1.35; CI, 1.29–1.42), and those with the shorter duration on ART (vs. greater than 40.37 months). Patents in rural health zones (AOR, 0.32) and semi-rural health zones (AOR, 0.79) were less likely to be at stage 1, compared to patients in urban health zones. Conclusions: Our study showed that TB co-infection raised the risk for PLHIV to be at the severe stages of clinical progression of HIV. Such variation supports the thesis that customized HIV management approaches and clinical regimens may be imperative for this high-risk population. We also found significant variation in HIV clinical progression stages by geographic location and demographic characteristics. Such variation points to the need for more targeted efforts to address the disparities, as the programs attempt to improve the effectiveness of HIV care and treatment. The intersectionality of vulnerabilities from HIV, TB, and COVID-19-related hardships has elevated the need for customized care and treatment even more in the COVID-19 era. MDPI 2021-05-17 /pmc/articles/PMC8156374/ /pubmed/34067847 http://dx.doi.org/10.3390/ijerph18105341 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Ewetola, Raimi
Shah, Gulzar H.
Maluantesa, Lievain
Etheredge, Gina
Waterfield, Kristie
Mulenga, Astrid
Kilundu, Apolinaire
Disparities in HIV Clinical Stages Progression of Patients at Outpatient Clinics in Democratic Republic of Congo
title Disparities in HIV Clinical Stages Progression of Patients at Outpatient Clinics in Democratic Republic of Congo
title_full Disparities in HIV Clinical Stages Progression of Patients at Outpatient Clinics in Democratic Republic of Congo
title_fullStr Disparities in HIV Clinical Stages Progression of Patients at Outpatient Clinics in Democratic Republic of Congo
title_full_unstemmed Disparities in HIV Clinical Stages Progression of Patients at Outpatient Clinics in Democratic Republic of Congo
title_short Disparities in HIV Clinical Stages Progression of Patients at Outpatient Clinics in Democratic Republic of Congo
title_sort disparities in hiv clinical stages progression of patients at outpatient clinics in democratic republic of congo
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8156374/
https://www.ncbi.nlm.nih.gov/pubmed/34067847
http://dx.doi.org/10.3390/ijerph18105341
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