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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...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BMJ Publishing Group
2022
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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 |
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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 |
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