Cargando…

Attrition and associated factors among children living with HIV at a tertiary hospital in Eritrea: a retrospective cohort analysis

BACKGROUND: Reducing attrition in paediatric HIV-positive patients using combined antiretroviral therapy (cART) programmes in sub-Saharan Africa is a challenge. This study explored the rates and predictors of attrition in children started on cART in Asmara, Eritrea. METHODS: This was a retrospective...

Descripción completa

Detalles Bibliográficos
Autores principales: Mengistu, Samuel Tekle, Ghebremeskel, Ghirmay Ghebrekidan, Rezene, Aron, Idris, Mahmud Mohammed, Tikue, Tsegereda Gebrehiwot, Hamida, Mohammed Elfatih, Achila, Oliver Okoth
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9252199/
https://www.ncbi.nlm.nih.gov/pubmed/36053603
http://dx.doi.org/10.1136/bmjpo-2022-001414
_version_ 1784740212171079680
author Mengistu, Samuel Tekle
Ghebremeskel, Ghirmay Ghebrekidan
Rezene, Aron
Idris, Mahmud Mohammed
Tikue, Tsegereda Gebrehiwot
Hamida, Mohammed Elfatih
Achila, Oliver Okoth
author_facet Mengistu, Samuel Tekle
Ghebremeskel, Ghirmay Ghebrekidan
Rezene, Aron
Idris, Mahmud Mohammed
Tikue, Tsegereda Gebrehiwot
Hamida, Mohammed Elfatih
Achila, Oliver Okoth
author_sort Mengistu, Samuel Tekle
collection PubMed
description BACKGROUND: Reducing attrition in paediatric HIV-positive patients using combined antiretroviral therapy (cART) programmes in sub-Saharan Africa is a challenge. This study explored the rates and predictors of attrition in children started on cART in Asmara, Eritrea. METHODS: This was a retrospective cohort study using data from all paediatric patients on cART between 2005 and 2020, conducted at the Orotta National Referral and Teaching Hospital. Kaplan-Meier estimates of the likelihood of attrition and multivariate Cox proportional hazards models were used to assess the factors associated with attrition. All p values were two sided and p<0.05 was considered statistically significant. RESULTS: The study enrolled 710 participants with 374 boys (52.7%) and 336 girls (47.3%). After 5364 person-years’ (PY) follow-up, attrition occurred in 172 (24.2%) patients: 65 (9.2%) died and 107 (15.1%) were lost to follow-up (LTFU). The crude incidence rate of attrition was 3.2 events/100 PY, mortality rate was 2.7/100 PY and LTFU was 1.2/100 PY. The independent predictors of attrition included male sex (adjusted HR (AHR)=1.6, 95% CI: 1 to 2.4), residence outside Zoba Maekel (AHR=1.5, 95% CI: 1 to 2.3), later enrolment years (2010–2015: AHR=3.2, 95% CI: 1.9 to 5.3; >2015: AHR=6.1, 95% CI: 3 to 12.2), WHO body mass index-for-age z-score <−2 (AHR=1.4, 95% CI: 0.9 to 2.1), advanced HIV disease (WHO III or IV) at enrolment (AHR=2.2, 95% CI: 1.2 to 3.9), and initiation of zidovudine+lamivudine or other cART backbones (unadjusted HR (UHR)=2, 95% CI: 1.2 to 3.2). In contrast, a reduced likelihood of attrition was observed in children with a record of cART changes (UHR=0.2, 95% CI: 0.15 to 0.4). CONCLUSION: A low incidence of attrition was observed in this study. However, the high mortality rate in the first 24 months of treatment and late presentation are concerning. Therefore, data-driven interventions for improving programme quality and outcomes should be prioritised.
format Online
Article
Text
id pubmed-9252199
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-92521992022-07-05 Attrition and associated factors among children living with HIV at a tertiary hospital in Eritrea: a retrospective cohort analysis Mengistu, Samuel Tekle Ghebremeskel, Ghirmay Ghebrekidan Rezene, Aron Idris, Mahmud Mohammed Tikue, Tsegereda Gebrehiwot Hamida, Mohammed Elfatih Achila, Oliver Okoth BMJ Paediatr Open Tropical Paediatrics BACKGROUND: Reducing attrition in paediatric HIV-positive patients using combined antiretroviral therapy (cART) programmes in sub-Saharan Africa is a challenge. This study explored the rates and predictors of attrition in children started on cART in Asmara, Eritrea. METHODS: This was a retrospective cohort study using data from all paediatric patients on cART between 2005 and 2020, conducted at the Orotta National Referral and Teaching Hospital. Kaplan-Meier estimates of the likelihood of attrition and multivariate Cox proportional hazards models were used to assess the factors associated with attrition. All p values were two sided and p<0.05 was considered statistically significant. RESULTS: The study enrolled 710 participants with 374 boys (52.7%) and 336 girls (47.3%). After 5364 person-years’ (PY) follow-up, attrition occurred in 172 (24.2%) patients: 65 (9.2%) died and 107 (15.1%) were lost to follow-up (LTFU). The crude incidence rate of attrition was 3.2 events/100 PY, mortality rate was 2.7/100 PY and LTFU was 1.2/100 PY. The independent predictors of attrition included male sex (adjusted HR (AHR)=1.6, 95% CI: 1 to 2.4), residence outside Zoba Maekel (AHR=1.5, 95% CI: 1 to 2.3), later enrolment years (2010–2015: AHR=3.2, 95% CI: 1.9 to 5.3; >2015: AHR=6.1, 95% CI: 3 to 12.2), WHO body mass index-for-age z-score <−2 (AHR=1.4, 95% CI: 0.9 to 2.1), advanced HIV disease (WHO III or IV) at enrolment (AHR=2.2, 95% CI: 1.2 to 3.9), and initiation of zidovudine+lamivudine or other cART backbones (unadjusted HR (UHR)=2, 95% CI: 1.2 to 3.2). In contrast, a reduced likelihood of attrition was observed in children with a record of cART changes (UHR=0.2, 95% CI: 0.15 to 0.4). CONCLUSION: A low incidence of attrition was observed in this study. However, the high mortality rate in the first 24 months of treatment and late presentation are concerning. Therefore, data-driven interventions for improving programme quality and outcomes should be prioritised. BMJ Publishing Group 2022-07-01 /pmc/articles/PMC9252199/ /pubmed/36053603 http://dx.doi.org/10.1136/bmjpo-2022-001414 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
spellingShingle Tropical Paediatrics
Mengistu, Samuel Tekle
Ghebremeskel, Ghirmay Ghebrekidan
Rezene, Aron
Idris, Mahmud Mohammed
Tikue, Tsegereda Gebrehiwot
Hamida, Mohammed Elfatih
Achila, Oliver Okoth
Attrition and associated factors among children living with HIV at a tertiary hospital in Eritrea: a retrospective cohort analysis
title Attrition and associated factors among children living with HIV at a tertiary hospital in Eritrea: a retrospective cohort analysis
title_full Attrition and associated factors among children living with HIV at a tertiary hospital in Eritrea: a retrospective cohort analysis
title_fullStr Attrition and associated factors among children living with HIV at a tertiary hospital in Eritrea: a retrospective cohort analysis
title_full_unstemmed Attrition and associated factors among children living with HIV at a tertiary hospital in Eritrea: a retrospective cohort analysis
title_short Attrition and associated factors among children living with HIV at a tertiary hospital in Eritrea: a retrospective cohort analysis
title_sort attrition and associated factors among children living with hiv at a tertiary hospital in eritrea: a retrospective cohort analysis
topic Tropical Paediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9252199/
https://www.ncbi.nlm.nih.gov/pubmed/36053603
http://dx.doi.org/10.1136/bmjpo-2022-001414
work_keys_str_mv AT mengistusamueltekle attritionandassociatedfactorsamongchildrenlivingwithhivatatertiaryhospitalineritreaaretrospectivecohortanalysis
AT ghebremeskelghirmayghebrekidan attritionandassociatedfactorsamongchildrenlivingwithhivatatertiaryhospitalineritreaaretrospectivecohortanalysis
AT rezenearon attritionandassociatedfactorsamongchildrenlivingwithhivatatertiaryhospitalineritreaaretrospectivecohortanalysis
AT idrismahmudmohammed attritionandassociatedfactorsamongchildrenlivingwithhivatatertiaryhospitalineritreaaretrospectivecohortanalysis
AT tikuetsegeredagebrehiwot attritionandassociatedfactorsamongchildrenlivingwithhivatatertiaryhospitalineritreaaretrospectivecohortanalysis
AT hamidamohammedelfatih attritionandassociatedfactorsamongchildrenlivingwithhivatatertiaryhospitalineritreaaretrospectivecohortanalysis
AT achilaoliverokoth attritionandassociatedfactorsamongchildrenlivingwithhivatatertiaryhospitalineritreaaretrospectivecohortanalysis