Retention in HIV Care for Individuals Not Yet Eligible for Antiretroviral Therapy: Rural KwaZulu-Natal, South Africa

被引:104
作者
Lessells, Richard J. [1 ,2 ]
Mutevedzi, Portia C. [1 ,3 ]
Cooke, Graham S. [1 ,4 ]
Newell, Marie-Louise [1 ,5 ]
机构
[1] Univ KwaZulu Natal, Africa Ctr Hlth & Populat Studies, ZA-3935 Mtubatuba, Kwazulu Natal, South Africa
[2] London Sch Hyg & Trop Med, Dept Clin Res, London WC1, England
[3] UCL Dept Infect & Populat Hlth, London, England
[4] Univ London Imperial Coll Sci Technol & Med, Dept Infect Dis, London, England
[5] UCL Inst Child Hlth, London, England
基金
英国惠康基金;
关键词
CD4; monitoring; HIV care; retention; South Africa; FOLLOW-UP; INFECTED PATIENTS; INCOME COUNTRIES; EARLY MORTALITY; SCALE-UP; COMMUNITY; OUTCOMES; COHORT; TRANSMISSION; PREVALENCE;
D O I
10.1097/QAI.0b013e3182075ae2
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Objectives: To determine retention in HIV care for individuals not yet eligible for antiretroviral therapy (ART) and to explore factors associated with retention in a rural public health HIV program. Methods: HIV-infected adults (>= 16 years) not yet eligible for ART, with CD4 cell count >200 cells per microliter from January 2007 to December 2007 were included in the analysis. Retention was defined by repeat CD4 count within 13 months. Factors associated with retention were assessed using logistic regression with clustering at clinic level. Results: Four thousand two hundred twenty-three were included in the analysis (83.9% female). Overall retention was 44.9% with median time to return 201 days [interquartile range (IQR): 127-274]. Retention by initial CD4 count 201-350, 351-500, and >500 cells per microliter was 51.6% [95% confidence interval (CI): 49.1 to 54.0], 43.2% (95% CI: 40.5 to 45.9), and 34.9% (95% CI: 32.4 to 37.4), respectively. Compared with CD4 201-350 cells per microliter, higher initial CD4 count was significantly associated with lower odds of retention [CD4: 351-500 cells/mu L adjusted odds ratio (aOR): 0.72, 95% CI: 0.62 to 0.84; CD4.500 cells/mu L aOR: 0.51, 95% CI: 0.44 to 0.60]. Male sex was independently associated with lower odds (aOR: 0.80, 95% CI: 0.67 to 0.96), and older age with higher odds of retention (for each additional year of age aOR: 1.03, 95% CI: 1.03 to 1.04). Conclusions: Retention in HIV care before eligibility for ART is poor, particularly for younger individuals and those at an earlier stage of infection. Further work to optimize and evaluate care and monitoring strategies is required to realize the full benefits of the rapid expansion of HIV programs in sub-Saharan Africa.
引用
收藏
页码:E79 / E86
页数:8
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