Factors associated with long-term antiretroviral therapy attrition among adolescents in rural Uganda: a retrospective study

Simple item page
dc.contributor.authorOkoboi, Stephen
dc.contributor.authorSsali, Livingstone
dc.contributor.authorYansaneh, Aisha I.
dc.contributor.authorBakanda, Celestin
dc.contributor.authorBirungi, Josephine
dc.contributor.authorNantume, Sophie
dc.contributor.authorOkullu, Joanne Lyavala
dc.contributor.authorSharp, Alana R.
dc.contributor.authorMoore, David M.
dc.contributor.authorKalibala, Samuel
dc.date.accessioned2018-07-26T12:54:58Z
dc.date.available2018-07-26T12:54:58Z
dc.date.issued2016-07
dc.descriptionAs access to antiretroviral therapy (ART) increases, the success of treatment programmes depends on ensuring high patient retention in HIV care. We examined retention and attrition among adolescents in ART programmes across clinics operated by The AIDS Support Organization (TASO) in Uganda, which has operated both facility- and community-based distribution models of ART delivery since 2004.en_US
dc.description.abstractIntroduction: As access to antiretroviral therapy (ART) increases, the success of treatment programmes depends on ensuring high patient retention in HIV care. We examined retention and attrition among adolescents in ART programmes across clinics operated by The AIDS Support Organization (TASO) in Uganda, which has operated both facility- and community-based distribution models of ART delivery since 2004. Methods: Using a retrospective cohort analysis of patient-level clinical data, we examined attrition and retention in HIV care and factors associated with attrition among HIV-positive adolescents aged 10–19 years who initiated ART at 10 TASO clinics between January 2006 and December 2011. Retention in care was defined as the proportion of adolescents who had had at least one facility visit within the six months prior to 1 June 2013, and attrition was defined as the proportion of adolescents who died, were lost to follow-up, or stopped treatment. Descriptive statistics and Cox proportional hazards regression models were used to determine the levels of retention in HIV care and the factors associated with attrition following ART initiation. Results: A total of 1228 adolescents began ART between 2006 and 2011, of whom 57% were female. The median duration in HIV care was four years (IQR=3–6 years). A total of 792 (65%) adolescents were retained in care over the five-year period; 36 (3%) had died or transferred out and 400 (32%) were classified as loss to follow-up. Factors associated with attrition included being older (adjusted hazard ratio (AHR)=1.38, 95% confidence interval (CI) 1.02–1.86), having a higher CD4 count (250+ cells/mm3) at treatment initiation (AHR=0.49, 95% CI 0.34–0.69) and HIV care site with a higher risk of attrition among adolescents in Gulu (AHR=2.26; 95% CI 1.27–4.02) and Masindi (AHR=3.30, 95% CI 1.87–5.84) and a lower risk of attrition in Jinja (AHR=0.24, 95% CI 0.08–0.70). Having an advanced WHO clinical stage at initiation was not associated with attrition. Conclusions: We found an overall retention rate of 65%, which is comparable to rates achieved by TASO's adult patients and adolescents in other studies in Africa. Variations in the risk of attrition by TASO treatment site and by clinical and demographic characteristics suggest the need for early diagnosis of HIV infection, use of innovative approaches to reach and retain adolescents living with HIV in treatment and identifying specific groups, such as older adolescents, that are at high risk of dropping out of treatment for targeted care and support.en_US
dc.identifier.citationOkoboi, Stephen, Ssali, Livingstone, Yansaneh, Aisha I., Bakanda, Celestin, Birungi Josephine, Nantume, Sophie, Okullu, Joanne Lyavala, Sharp, Alana R., Moore, David M. and Kalibala, Samuel, 2016. Factors associated with long-term antiretroviral therapy attrition among adolescents in rural Uganda: a retrospective studyen_US
dc.identifier.urihttps://hdl.handle.net/20.500.11951/317
dc.language.isoenen_US
dc.publisherWiley-Blackwellen_US
dc.subjectAdolescentsen_US
dc.subjectHIV treatmenten_US
dc.subjectAntiretroviral therapyen_US
dc.subjectRetentionen_US
dc.subjectAttritionen_US
dc.subjectCommunity-based deliveryen_US
dc.subjectUgandaen_US
dc.titleFactors associated with long-term antiretroviral therapy attrition among adolescents in rural Uganda: a retrospective studyen_US
dc.typeArticleen_US
Files
Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
Okoboi et al._Factors associated with long-term antiretroviral therapy attrition among adolescents in rural Uganda a retrospective study_2016.pdf
Size:
257.17 KB
Format:
Adobe Portable Document Format
Description:
Download
License bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
license.txt
Size:
1.97 KB
Format:
Item-specific license agreed upon to submission
Description:
Download
Collections
UCU School of Medicine