Agbaji O O, Abah I O, Falang K D, Ebonyi A O, Musa J, Ugoagwu P, Agaba P A, Sagay A S, Jolayemi T, Okonkwo P, Idoko J A, Kanki Phyllis J
Pharmacy Department, Jos University Teaching Hospital, Jos, Nigeria.
Curr HIV Res. 2015;13(3):184-92. doi: 10.2174/1570162x1303150506181945.
BACKGROUND: Retention in care and treatment services is critical to health outcomes of individuals diagnosed and living with HIV. We evaluated the incidence of and risk factors for treatment discontinuation (TD) in a large adult HIV population on ART in Nigeria. METHOD: A retrospective cohort study of adult HIV patients initiated on first-line ART between 2004 and 2011 at the Jos University Teaching Hospital (JUTH) in Nigeria. Follow up information of participants was retrieved from various sources (patient visit database, pharmacy data and patients charts) up to the end of 2012. The primary study endpoint was TD, defined as discontinuation of ART for any reason, including death or loss to follow-up (lack of pharmacy pick-up for periods≥12 months). The Incidence and hazard for TD were estimated by Kaplan-Meier and Cox proportional regression analysis, respectively. RESULT: Overall, 3,362 (28%) patients discontinued treatment during 49,436 person-years (py) of follow-up (incidence rate (IR) 6.8 TD per 100 py). The hazard of treatment discontinuation decreased with increasing age (adjusted hazard ratio (aHR 0.99; 95% CI 0.98-0.99). Other independent risk factors for treatment discontinuation were: being unmarried (aHR 1.24; 95% CI: 1.12-1.38), having primary or secondary level of education as compared to tertiary level education (aHR 1.24; 95% CI: 1.12-1.40) and average percent adherence to drug refill visits<95% (adjusted hazard ratio (aHR) 2.13; 95% CI: 1.9-2.40). Compared to tenofovir, greater hazard of TD was noted in patients initiated on ART containing didanosine (aHR) 1.73; 95% CI: 1.03-2.91), but lower in those initiated on zidovudine containing regimen (aHR 0.77; 95% CI: 0.69-0.86). CONCLUSION: Long-term treatment discontinuation rate in this study was comparable to estimates in resource-rich countries. Younger patients, as well as patients with lower educational levels and those with poor adherence had significant hazards for treatment discontinuation and should be the target of interventions to reduce treatment discontinuation and improve retention, especially within the first year of ART.
背景：坚持接受护理和治疗服务对于被诊断感染艾滋病毒并与之共存的个体的健康结果至关重要。我们评估了尼日利亚大量接受抗逆转录病毒治疗（ART）的成年艾滋病毒感染者中治疗中断（TD）的发生率及危险因素。 方法：对2004年至2011年期间在尼日利亚乔斯大学教学医院（JUTH）开始接受一线抗逆转录病毒治疗的成年艾滋病毒患者进行回顾性队列研究。截至2012年底，从各种来源（患者就诊数据库、药房数据和患者病历）获取参与者的随访信息。主要研究终点为治疗中断，定义为因任何原因停止抗逆转录病毒治疗，包括死亡或失访（连续≥12个月未取药）。分别通过Kaplan-Meier法和Cox比例回归分析估计治疗中断的发生率和风险。 结果：总体而言，在49436人年的随访期间，3362名（28%）患者停止治疗（发病率为每100人年6.8例治疗中断）。治疗中断的风险随年龄增长而降低（调整后风险比（aHR）为0.99；95%置信区间为0.98 - 0.99）。治疗中断的其他独立危险因素包括：未婚（aHR为1.24；95%置信区间：1.12 - 1.38）、与接受高等教育相比接受小学或中学教育（aHR为1.24；95%置信区间：1.12 - 1.40）以及药物补服就诊的平均依从率<95%（调整后风险比（aHR）为2.13；95%置信区间：1.9 - 2.40）。与替诺福韦相比，开始接受含去羟肌苷的抗逆转录病毒治疗的患者治疗中断风险更高（aHR为1.73；95%置信区间：1.03 - 2.91），但开始接受含齐多夫定方案治疗的患者风险较低（aHR为0.77；95%置信区间：0.69 - 0.86）。 结论：本研究中的长期治疗中断率与资源丰富国家的估计值相当。年轻患者、教育水平较低的患者以及依从性差的患者治疗中断风险显著，应成为减少治疗中断和提高治疗坚持率干预措施的目标人群，尤其是在抗逆转录病毒治疗的第一年。
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