Wekesa Paul, McLigeyo Angela, Owuor Kevin, Mwangi Jonathan, Nganga Evelyne, Masamaro Kenneth
Centre for Health Solutions, Nairobi, Kenya.
Division of Global HIV & TB, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya.
BMC Public Health. 2020 Mar 14;20(1):328. doi: 10.1186/s12889-020-8426-1.
The scale-up of HIV treatment programs has resulted in a reduction in HIV-related morbidity and mortality. However, retention of patients in these programs remains a challenge in sub-Saharan Africa. Understanding factors associated with loss to follow-up (LTFU) and mortality outcomes is therefore important to inform targeted program interventions.
A retrospective multi-cohort analysis of 23,890 adult patients on ART over 36 months of follow-up in Kenya was done. Multivariate logistic regression analysis was done to assess for factors associated with LTFU and mortality at 6, 12, 24, and 36 months of follow-up.
Majority, 67.7%, were female. At 36 months, 27.2% were LTFU and 13.5% had died. Factors associated with mortality at 36 months included older age (51 years and above) using 20-35 years as reference [(adjusted odds ratio [aOR], 1.51, 95% confidence interval (CI) 1.23-1.86, p < 0.001], being male (aOR, 1.59, 95% CI 1.39-1.83, p < 0.001), divorced using married as reference (aOR, 1.86, 95% CI 1.56-2.22, p < 0.001), having a body mass index (BMI) score of less than 18.5 kg/m using 18.5-24.9 kg/m as reference (aOR = 1.79, 95% CI 1.52-2.11, p < 0.001), and, World Health Organization stage III and IV using stage I as the reference (aOR, 1.94, 95% CI 1.43-2.63 and aOR, 4.24, 95% CI 3.06-5.87, p < 0.001 respectively). Factors associated with LTFU at 36 months included being young between 20 and 35 years (aOR, 1.49, 95% CI 1.40-1.59, p < 0.001) using 36-50 years as reference, being male (aOR, 1.19, 95% CI 1.12-1.27, p < 0.001), and being single or divorced using married as reference (aOR, 1.34, 95% CI 1.23-1.45 and aOR, 1.25, 95% CI 1.15-1.36, p < 0.001 respectively). Patients with baseline BMI of less than 18.5 kg/m using normal BMI as reference (aOR, 1.68, 95% CI 1.39-2.02, p < 0.001) were also likely to be LTFU.
Factors associated with LTFU and mortality were generally similar over time. Implementation of programs in similar settings should be tailored to gender, age profiles, nutritional, and, marital status of patients to address LTFU. In addition, programs should focus on the care of older patients to reduce the risk of mortality.
扩大艾滋病毒治疗项目已使与艾滋病毒相关的发病率和死亡率有所降低。然而，在撒哈拉以南非洲，让患者持续参与这些项目仍是一项挑战。因此，了解与失访（LTFU）和死亡结果相关的因素对于制定有针对性的项目干预措施很重要。
对肯尼亚23,890名接受抗逆转录病毒治疗（ART）的成年患者进行了为期36个月随访的回顾性多队列分析。采用多变量逻辑回归分析来评估在随访6个月、12个月、24个月和36个月时与LTFU和死亡相关的因素。
大多数患者（67.7%）为女性。在36个月时，27.2%的患者失访，13.5%的患者死亡。与36个月时死亡相关的因素包括年龄较大（51岁及以上，以20 - 35岁为参照）（调整后的优势比[aOR]为1.51，95%置信区间[CI]为1.23 - 1.86，p < 0.001）、男性（aOR为1.59，95% CI为1.39 - 1.83，p < 0.001）、以已婚为参照的离婚者（aOR为1.86，95% CI为1.56 - 2.22，p < 0.001）、以体重指数（BMI）18.5 - 24.9kg/m²为参照的BMI得分低于18.5kg/m²者（aOR = 1.79，95% CI为1.52 - 2.11，p < 0.001），以及以世界卫生组织I期为参照的III期和IV期患者（aOR分别为1.94，95% CI为1.43 - 2.63和aOR为4.24，95% CI为3.06 - 5.87，p均< 0.001）。与36个月时LTFU相关的因素包括年龄在20 - 35岁之间（以36 - 50岁为参照，aOR为1.49，95% CI为1.40 - 1.59，p < 0.001）、男性（aOR为1.19，95% CI为1.12 - 1.27，p < 0.001），以及以已婚为参照的单身或离婚者（aOR分别为1.34，95% CI为1.23 - 1.45和aOR为1.25，95% CI为1.15 - 1.36，p均< 0.001）。以正常BMI为参照的基线BMI低于18.5kg/m²的患者也更有可能失访（aOR为1.68，95% CI为1.39 - 2.02，p < 0.001）。
随着时间推移，与LTFU和死亡相关的因素总体上相似。在类似环境中实施项目应根据患者的性别、年龄分布、营养状况和婚姻状况进行调整，以解决LTFU问题。此外，项目应关注老年患者的护理，以降低死亡风险。
