Retention in care among HIV-positive patients initiating second-line antiretroviral therapy: a retrospective study from an Ethiopian public hospital clinic

• Published in: Global health action Vol. 9; no. 1; p. 29943
• Main Authors: Wilhelmson, Sten, Reepalu, Anton, Tolera Balcha, Taye, Jarso, Godana, Björkman, Per
• Format: Journal Article
• Language: English
• Published: United States Taylor & Francis 01-01-2016; Taylor & Francis Ltd; Co-Action Publishing; Taylor & Francis Group
• Subjects: Adolescent; Adolescents; Adult; Adults; Aged; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; CD4 Lymphocyte Count; Change agents; Drug therapy; Ethiopia; Female; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi; Health Sciences; HIV; HIV Infections - drug therapy; HIV Infections - mortality; Hospitals, Public; Human immunodeficiency virus; Humans; Hälsovetenskap; Immune response; loss to follow-up; Lost to Follow-Up; Male; Medical and Health Sciences; Medication Adherence; Medicin och hälsovetenskap; Middle Aged; Multivariate analysis; Original; Patients; Proportional Hazards Models; Public Health, Global Health, Social Medicine and Epidemiology; Retention; retention in care; Retrospective Studies; second-line; sub-Saharan Africa; Teenagers; Treatment Failure; Young Adult; Ethiopia; sub-Saharan Africa; second-line; HIV; antiretroviral therapy; loss to follow-up; retention in care; Ethiopia
• ISSN: 1654-9716; 1654-9880; 1654-9880
• DOI: 10.3402/gha.v9.29943

Access to second-line antiretroviral therapy (ART) for HIV-positive patients remains limited in sub-Saharan Africa. Furthermore, outcomes of second-line ART may be compromised by mortality and loss to follow-up (LTFU).
To determine retention in care among patients receiving second-line ART in a public hospital in Ethiopia, and to investigate factors associated with LTFU among adults and adolescents.
HIV-positive persons with documented change of first-line ART to a second-line regimen were retrospectively identified from hospital registers, and data were collected at the time of treatment change and subsequent clinic visits. Baseline variables for adults and adolescents were analyzed using multivariate Cox proportional hazards models comparing subjects remaining in care and those LTFU (defined as a missed appointment of ≥90 days).
A total of 383 persons had started second-line ART (330 adults/adolescents; 53 children) and were followed for a median of 22.2 months (the total follow-up time was 906 person years). At the end of study follow-up, 80.5% of patients remained in care (adults and adolescents 79.8%; children 85.7%). In multivariate analysis, LTFU among adults and adolescents was associated with a baseline CD4 cell count <100 cells/mm
3
and a first-line regimen failure that was not confirmed by HIV RNA testing.
Although retention in care during second-line ART in this cohort was satisfactory, and similar to that reported from first-line ART programs in Ethiopia, our findings suggest the benefit of earlier recognition of patients with first-line ART failure and confirmation of suspected treatment failure by viral load testing.