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Loss to Follow-Up Risk among HIV Patients on ART in Zimbabwe, 2009–2016: Hierarchical Bayesian Spatio-Temporal Modeling

Loss to follow-up (LTFU) is a risk factor for poor outcomes in HIV patients. The spatio-temporal risk of LTFU is useful to identify hotspots and guide policy. Secondary data on adult HIV patients attending a clinic in provinces of Zimbabwe between 2009 and 2016 were used to estimate the LTFU risk in...

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Autores principales: Matsena Zingoni, Zvifadzo, Chirwa, Tobias, Todd, Jim, Musenge, Eustasius
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9518110/
https://www.ncbi.nlm.nih.gov/pubmed/36078729
http://dx.doi.org/10.3390/ijerph191711013
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author Matsena Zingoni, Zvifadzo
Chirwa, Tobias
Todd, Jim
Musenge, Eustasius
author_facet Matsena Zingoni, Zvifadzo
Chirwa, Tobias
Todd, Jim
Musenge, Eustasius
author_sort Matsena Zingoni, Zvifadzo
collection PubMed
description Loss to follow-up (LTFU) is a risk factor for poor outcomes in HIV patients. The spatio-temporal risk of LTFU is useful to identify hotspots and guide policy. Secondary data on adult HIV patients attending a clinic in provinces of Zimbabwe between 2009 and 2016 were used to estimate the LTFU risk in each of the 10 provinces. A hierarchical Bayesian spatio-temporal Poisson regression model was fitted using the Integrated Nested Laplace Approximation (INLA) package with LTFU as counts adjusting for age, gender, WHO clinical stage, tuberculosis coinfection and duration on ART. The structured random effects were modelled using the conditional autoregression technique and the temporal random effects were modelled using first-order random walk Gaussian priors. The overall rate of LTFU was 22.7% (95%CI: 22.6/22.8) with Harare (50.28%) and Bulawayo (31.11%) having the highest rates. A one-year increase in the average number of years on ART reduced the risk of LTFU by 35% (relative risk (RR) = 0.651; 95%CI: 0.592–0.712). In general, the provinces with the highest exceedance LTFU risk were Matabeleland South and Matabeleland North. LTFU is one of the drawbacks of HIV prevention. Interventions targeting high-risk regions in the southern and northern regions of Zimbabwe are a priority. Community-based interventions and programmes which mitigate LTFU risk remain essential in the global HIV prevention campaign.
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spelling pubmed-95181102022-09-29 Loss to Follow-Up Risk among HIV Patients on ART in Zimbabwe, 2009–2016: Hierarchical Bayesian Spatio-Temporal Modeling Matsena Zingoni, Zvifadzo Chirwa, Tobias Todd, Jim Musenge, Eustasius Int J Environ Res Public Health Article Loss to follow-up (LTFU) is a risk factor for poor outcomes in HIV patients. The spatio-temporal risk of LTFU is useful to identify hotspots and guide policy. Secondary data on adult HIV patients attending a clinic in provinces of Zimbabwe between 2009 and 2016 were used to estimate the LTFU risk in each of the 10 provinces. A hierarchical Bayesian spatio-temporal Poisson regression model was fitted using the Integrated Nested Laplace Approximation (INLA) package with LTFU as counts adjusting for age, gender, WHO clinical stage, tuberculosis coinfection and duration on ART. The structured random effects were modelled using the conditional autoregression technique and the temporal random effects were modelled using first-order random walk Gaussian priors. The overall rate of LTFU was 22.7% (95%CI: 22.6/22.8) with Harare (50.28%) and Bulawayo (31.11%) having the highest rates. A one-year increase in the average number of years on ART reduced the risk of LTFU by 35% (relative risk (RR) = 0.651; 95%CI: 0.592–0.712). In general, the provinces with the highest exceedance LTFU risk were Matabeleland South and Matabeleland North. LTFU is one of the drawbacks of HIV prevention. Interventions targeting high-risk regions in the southern and northern regions of Zimbabwe are a priority. Community-based interventions and programmes which mitigate LTFU risk remain essential in the global HIV prevention campaign. MDPI 2022-09-02 /pmc/articles/PMC9518110/ /pubmed/36078729 http://dx.doi.org/10.3390/ijerph191711013 Text en © 2022 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
Matsena Zingoni, Zvifadzo
Chirwa, Tobias
Todd, Jim
Musenge, Eustasius
Loss to Follow-Up Risk among HIV Patients on ART in Zimbabwe, 2009–2016: Hierarchical Bayesian Spatio-Temporal Modeling
title Loss to Follow-Up Risk among HIV Patients on ART in Zimbabwe, 2009–2016: Hierarchical Bayesian Spatio-Temporal Modeling
title_full Loss to Follow-Up Risk among HIV Patients on ART in Zimbabwe, 2009–2016: Hierarchical Bayesian Spatio-Temporal Modeling
title_fullStr Loss to Follow-Up Risk among HIV Patients on ART in Zimbabwe, 2009–2016: Hierarchical Bayesian Spatio-Temporal Modeling
title_full_unstemmed Loss to Follow-Up Risk among HIV Patients on ART in Zimbabwe, 2009–2016: Hierarchical Bayesian Spatio-Temporal Modeling
title_short Loss to Follow-Up Risk among HIV Patients on ART in Zimbabwe, 2009–2016: Hierarchical Bayesian Spatio-Temporal Modeling
title_sort loss to follow-up risk among hiv patients on art in zimbabwe, 2009–2016: hierarchical bayesian spatio-temporal modeling
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9518110/
https://www.ncbi.nlm.nih.gov/pubmed/36078729
http://dx.doi.org/10.3390/ijerph191711013
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