Eearly loss of HIV-infected patients on potent antiretroviral therapy programmes in lower-income countries

• DOI: 10.2471/blt.07.044248
• Publication Date: 2008-09-01T12:29:04Z
• Authors: Francois Dabis
• Keywords: Adult; Male; Asia; Adolescent; International Cooperation; Antiretroviral Therapy; 610; HIV Infections; Health Services Accessibility; 03 medical and health sciences; 0302 clinical medicine; Risk Factors; Antiretroviral Therapy, Highly Active; 616; Humans; Highly Active; Developing Countries; Primary Care; Proportional Hazards Models; Public Health Informatics; *HIV-1; South America; Continuity of Patient Care; Middle Aged; Patient Acceptance of Health Care; CD4 Lymphocyte Count; 3. Good health; Logistic Models; [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie; Africa; HIV-1; [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie; Female; Health Services Research; *Developing Countries; Public aspects of medicine; RA1-1270; Program Evaluation

Objective To analyse the early loss of patients to antiretroviral therapy (ART) programmes in resource-limited settings.Methods Using data on 5491 adult starting ART (median age 35 years, 46% female) 15 treatment Africa, Asia and South America with ³ 12 months follow-up, we investigated risk factors for no follow-up after initiation, or death first 6 months.Findings Overall, 211 (3.8%) had 880 (16.0%) were lost 141 (2.6%) known have died months.The probability was higher 2003-2004 than 2000 earlier (odds ratio, OR: 5.06; 95% confidence interval, CI: 1.28-20.0),as (hazard HR: 7.62; 4.55-12.8)but not recorded (HR: 1.02; 0.44-2.36).Compared a baseline CD4-cell count 50 cells/µl, < 25 cells/µl associated (OR: 2.49; 1.43-4.33),loss 1.48; 1.23-1.77)and 3.34; 2.10-5.30).Compared free treatment, fee-for-service 3.71; 0.97-16.05)and mortality 4.64; 1.11-19.41).Conclusion Early patient losses increasingly common when scaled up fee service advanced immunodeficiency at baseline.Measures maximize programme retention are required resource-poor countries.