Predictors of attrition from care at 2 years in a prospective cohort of HIV-infected adults in Tigray, Ethiopia

Raffaella Bucciardini; Vincenzo Fragola; Teshome Abegaz; Stefano Lucattini; Atakilt Halifom; Eskedar Tadesse; Micheal Berhe; Katherina Pugliese; Luca Fucili; Massimiliano Di Gregorio; Marco Mirra; Paola De Castro; Roberta Terlizzi; Paola Tatarelli; Andrea Binelli; Teame Zegeye; Michela Campagnoli; Stefano Vella; Loko Abraham; Hagos Godefay

doi:10.1136/bmjgh-2017-000325

Predictors of attrition from care at 2 years in a prospective cohort of HIV-infected adults in Tigray, Ethiopia

Raffaella Bucciardini, Vincenzo Fragola, Teshome Abegaz, Stefano Lucattini, Atakilt Halifom, Eskedar Tadesse, Micheal Berhe, Katherina Pugliese, Luca Fucili, Massimiliano Di Gregorio, Marco Mirra, Paola De Castro, Roberta Terlizzi, Paola Tatarelli, Andrea Binelli, Teame Zegeye, Michela Campagnoli, Stefano Vella, Loko Abraham, Hagos Godefay

Istituto Superiore di Sanita'

Research output: Contribution to journal › Article › peer-review

Abstract

INTRODUCTION: Ethiopia has experienced rapid expansion of antiretroviral therapy (ART). However, as long-term retention in ART therapy is key for ART effectiveness, determinants of attrition need to be identified so appropriate interventions can be designed.

METHODS: We used data from the 'Cohort of African people Starting Antiretroviral therapy' (CASA) project, a prospective study of a cohort of HIV-infected patients who started ART in seven health facilities (HFs). We analysed the data of patients who had started first-line ART between January 2013 and December 2014. The Kaplan-Meier method was used to estimate the probability of retention at different time points. The Cox proportional hazards model was used to identify factors associated with attrition.

RESULTS: A total of 1198 patients were included in the study. Kaplan-Meier estimates of retention in care were 83.9%, 82.1% and 79.8% at 12, 18 and 24 months after starting ART, respectively. Attrition was mainly due to loss to follow-up, transferred-out patients and documented mortality. A multivariate Cox proportional hazard model showed that male sex, CD4 count <200 cells/µL and the type of HF were significantly associated with attrition.

CONCLUSIONS: The observed attrition differences according to gender suggest that separate interventions designed for women and men should be explored. Moreover, innovative strategies to increase HIV testing should be supported to avoid CD4 levels falling too low, a factor significantly associated with higher attrition in our study. Finally, specific studies to analyse the reasons for different levels of attrition among HFs are required.

Original language	English
Pages (from-to)	e000325
Journal	Annals of Global Health
Volume	2
Issue number	3
DOIs	https://doi.org/10.1136/bmjgh-2017-000325
Publication status	Published - 2017

Keywords

HIV infection
Adults
Ethiopia
Prospective studies
Cohort studies

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10.1136/bmjgh-2017-000325

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Bucciardini, R., Fragola, V., Abegaz, T., Lucattini, S., Halifom, A., Tadesse, E., Berhe, M., Pugliese, K., Fucili, L., Gregorio, M. D., Mirra, M., De Castro, P., Terlizzi, R., Tatarelli, P., Binelli, A., Zegeye, T., Campagnoli, M., Vella, S., Abraham, L., & Godefay, H. (2017). Predictors of attrition from care at 2 years in a prospective cohort of HIV-infected adults in Tigray, Ethiopia. Annals of Global Health, 2(3), e000325. https://doi.org/10.1136/bmjgh-2017-000325

Bucciardini, R , Fragola, V, Abegaz, T, Lucattini, S, Halifom, A, Tadesse, E, Berhe, M, Pugliese, K, Fucili, L, Gregorio, MD, Mirra, M, De Castro, P, Terlizzi, R, Tatarelli, P, Binelli, A, Zegeye, T, Campagnoli, M, Vella, S, Abraham, L & Godefay, H 2017, 'Predictors of attrition from care at 2 years in a prospective cohort of HIV-infected adults in Tigray, Ethiopia', Annals of Global Health, vol. 2, no. 3, pp. e000325. https://doi.org/10.1136/bmjgh-2017-000325

@article{0595fc6ff08940d0b99a169c349cee69,

title = "Predictors of attrition from care at 2 years in a prospective cohort of HIV-infected adults in Tigray, Ethiopia",

abstract = "INTRODUCTION: Ethiopia has experienced rapid expansion of antiretroviral therapy (ART). However, as long-term retention in ART therapy is key for ART effectiveness, determinants of attrition need to be identified so appropriate interventions can be designed.METHODS: We used data from the 'Cohort of African people Starting Antiretroviral therapy' (CASA) project, a prospective study of a cohort of HIV-infected patients who started ART in seven health facilities (HFs). We analysed the data of patients who had started first-line ART between January 2013 and December 2014. The Kaplan-Meier method was used to estimate the probability of retention at different time points. The Cox proportional hazards model was used to identify factors associated with attrition.RESULTS: A total of 1198 patients were included in the study. Kaplan-Meier estimates of retention in care were 83.9%, 82.1% and 79.8% at 12, 18 and 24 months after starting ART, respectively. Attrition was mainly due to loss to follow-up, transferred-out patients and documented mortality. A multivariate Cox proportional hazard model showed that male sex, CD4 count <200 cells/µL and the type of HF were significantly associated with attrition.CONCLUSIONS: The observed attrition differences according to gender suggest that separate interventions designed for women and men should be explored. Moreover, innovative strategies to increase HIV testing should be supported to avoid CD4 levels falling too low, a factor significantly associated with higher attrition in our study. Finally, specific studies to analyse the reasons for different levels of attrition among HFs are required.",

keywords = "HIV infection, Adults, Ethiopia, Prospective studies, Cohort studies",

author = "Raffaella Bucciardini and Vincenzo Fragola and Teshome Abegaz and Stefano Lucattini and Atakilt Halifom and Eskedar Tadesse and Micheal Berhe and Katherina Pugliese and Luca Fucili and Gregorio, {Massimiliano Di} and Marco Mirra and {De Castro}, Paola and Roberta Terlizzi and Paola Tatarelli and Andrea Binelli and Teame Zegeye and Michela Campagnoli and Stefano Vella and Loko Abraham and Hagos Godefay",

year = "2017",

doi = "10.1136/bmjgh-2017-000325",

language = "English",

volume = "2",

pages = "e000325",

journal = "Mount Sinai Journal of Medicine",

issn = "0027-2507",

publisher = "Elsevier Inc.",

number = "3",

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TY - JOUR

T1 - Predictors of attrition from care at 2 years in a prospective cohort of HIV-infected adults in Tigray, Ethiopia

AU - Bucciardini, Raffaella

AU - Fragola, Vincenzo

AU - Abegaz, Teshome

AU - Lucattini, Stefano

AU - Halifom, Atakilt

AU - Tadesse, Eskedar

AU - Berhe, Micheal

AU - Pugliese, Katherina

AU - Fucili, Luca

AU - Gregorio, Massimiliano Di

AU - Mirra, Marco

AU - De Castro, Paola

AU - Terlizzi, Roberta

AU - Tatarelli, Paola

AU - Binelli, Andrea

AU - Zegeye, Teame

AU - Campagnoli, Michela

AU - Vella, Stefano

AU - Abraham, Loko

AU - Godefay, Hagos

PY - 2017

Y1 - 2017

N2 - INTRODUCTION: Ethiopia has experienced rapid expansion of antiretroviral therapy (ART). However, as long-term retention in ART therapy is key for ART effectiveness, determinants of attrition need to be identified so appropriate interventions can be designed.METHODS: We used data from the 'Cohort of African people Starting Antiretroviral therapy' (CASA) project, a prospective study of a cohort of HIV-infected patients who started ART in seven health facilities (HFs). We analysed the data of patients who had started first-line ART between January 2013 and December 2014. The Kaplan-Meier method was used to estimate the probability of retention at different time points. The Cox proportional hazards model was used to identify factors associated with attrition.RESULTS: A total of 1198 patients were included in the study. Kaplan-Meier estimates of retention in care were 83.9%, 82.1% and 79.8% at 12, 18 and 24 months after starting ART, respectively. Attrition was mainly due to loss to follow-up, transferred-out patients and documented mortality. A multivariate Cox proportional hazard model showed that male sex, CD4 count <200 cells/µL and the type of HF were significantly associated with attrition.CONCLUSIONS: The observed attrition differences according to gender suggest that separate interventions designed for women and men should be explored. Moreover, innovative strategies to increase HIV testing should be supported to avoid CD4 levels falling too low, a factor significantly associated with higher attrition in our study. Finally, specific studies to analyse the reasons for different levels of attrition among HFs are required.

AB - INTRODUCTION: Ethiopia has experienced rapid expansion of antiretroviral therapy (ART). However, as long-term retention in ART therapy is key for ART effectiveness, determinants of attrition need to be identified so appropriate interventions can be designed.METHODS: We used data from the 'Cohort of African people Starting Antiretroviral therapy' (CASA) project, a prospective study of a cohort of HIV-infected patients who started ART in seven health facilities (HFs). We analysed the data of patients who had started first-line ART between January 2013 and December 2014. The Kaplan-Meier method was used to estimate the probability of retention at different time points. The Cox proportional hazards model was used to identify factors associated with attrition.RESULTS: A total of 1198 patients were included in the study. Kaplan-Meier estimates of retention in care were 83.9%, 82.1% and 79.8% at 12, 18 and 24 months after starting ART, respectively. Attrition was mainly due to loss to follow-up, transferred-out patients and documented mortality. A multivariate Cox proportional hazard model showed that male sex, CD4 count <200 cells/µL and the type of HF were significantly associated with attrition.CONCLUSIONS: The observed attrition differences according to gender suggest that separate interventions designed for women and men should be explored. Moreover, innovative strategies to increase HIV testing should be supported to avoid CD4 levels falling too low, a factor significantly associated with higher attrition in our study. Finally, specific studies to analyse the reasons for different levels of attrition among HFs are required.

KW - HIV infection

KW - Adults

KW - Ethiopia

KW - Prospective studies

KW - Cohort studies

U2 - 10.1136/bmjgh-2017-000325

DO - 10.1136/bmjgh-2017-000325

M3 - Article

C2 - 29082011

SN - 0027-2507

VL - 2

SP - e000325

JO - Mount Sinai Journal of Medicine

JF - Mount Sinai Journal of Medicine

IS - 3

ER -

Predictors of attrition from care at 2 years in a prospective cohort of HIV-infected adults in Tigray, Ethiopia

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Keywords

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