Loss to Follow-up Trends in HIV-Positive Patients Receiving Antiretroviral Treatment in Asia From 2003 to 2013

被引:20
作者
De la Mata, Nicole L. [1 ]
Ly, Penh S. [2 ]
Nguyen, Kinh V. [3 ]
Merati, Tuti P. [4 ,5 ]
Pham, Thuy T. [6 ]
Lee, Man P. [7 ]
Choi, Jun Y. [8 ,9 ]
Ross, Jeremy [10 ]
Law, Matthew G. [1 ]
Ng, Oon T. [11 ]
机构
[1] UNSW Sydney, Kirby Inst, Biostat & Databases Program, Sydney, NSW, Australia
[2] Natl Ctr HIV AIDS, Dermatol & STDs, Phnom Penh, Cambodia
[3] Natl Hosp Trop Dis, Hanoi, Vietnam
[4] Udayana Univ, Dept Internal Med Trop & Infect Dis, Bali, Indonesia
[5] Sanglah Hosp, Bali, Indonesia
[6] Bach Mai Hosp, Hanoi, Vietnam
[7] Queen Elizabeth Hosp, Dept Med, Hong Kong, Hong Kong, Peoples R China
[8] Yonsei Univ, Coll Med, Severance Hosp, Dept Internal Med, Seoul, South Korea
[9] Yonsei Univ, Coll Med, Severance Hosp, AIDS Res Inst, Seoul, South Korea
[10] AmfAR Fdn AIDS Res, TREAT Asia, Bangkok, Thailand
[11] Tan Tock Seng Hosp, Dept Infect Dis, Novena, Singapore
基金
美国国家卫生研究院;
关键词
Asia; HIV; epidemiology; retention in care; loss to follow-up; ART; INJECTING DRUG-USERS; TREATMENT PROGRAMS; THERAPY PROGRAMS; INFECTED PATIENTS; SCALE-UP; OUTCOMES; CARE; RETENTION; MORTALITY; AFRICA;
D O I
10.1097/QAI.0000000000001293
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Introduction: Over time, there has been a substantial improvement in antiretroviral treatment (ART) programs, including expansion of services and increased patient engagement. We describe time trends in, and factors associated with, loss to follow-up (LTFU) in HIV-positive patients receiving ART in Asia. Methods: Analysis included HIV-positive adults initiating ART in 2003-2013 at 7 ART programs in Asia. Patients LTFU had not attended the clinic for >= 180 days, had not died, or transferred to another clinic. Patients were censored at recent clinic visit, follow-up to January 2014. We used cumulative incidence to compare LTFU and mortality between years of ART initiation. Factors associated with LTFU were evaluated using a competing risks regression model, adjusted for clinical site. Results: A total of 8305 patients were included. There were 743 patients LTFU and 352 deaths over 26,217 person-years (pys), a crude LTFU, and mortality rate of 2.83 (2.64-3.05) per 100 pys and 1.34 (1.21-1.49) per 100 pys, respectively. At 24 months, the cumulative LTFU incidence increased from 4.3% (2.9%-6.1%) in 2003-05 to 8.1% (7.1%-9.2%) in 2006-09 and then decreased to 6.7% (5.9%-7.5%) in 2010-13. Concurrently, the cumulative mortality incidence decreased from 6.2% (4.5%-8.2%) in 2003-05 to 3.3% (2.8%-3.9%) in 2010-13. The risk of LTFU reduced in 2010-13 compared with 2006-09 (adjusted subhazard ratio = 0.73, 0.69-0.99). Conclusions: LTFU rates in HIV-positive patients receiving ART in our clinical sites have varied by the year of ART initiation, with rates declining in recent years whereas mortality rates have remained stable. Further increases in site-level resources are likely to contribute to additional reductions in LTFU for patients initiating in subsequent years.
引用
收藏
页码:555 / 562
页数:8
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