Gaspard Tekpa, Jules Inikoutiyo, Christian Yonli, Celia Noguera, Pierre Prince Lujwiro, Laure Gigout, Aboubacar Hachimou, Sydney Romaric, Raphaël Mabaïlao, Marie Charlotte Banthas, Larissa Bertille Mbia, Paulette Rose Mbay, Kevin Romuald, Alain Sana, Florida Roberte, Laura Moretó-Planas, Eric Goemaere, Calorine Mekiedje, Stella Ouanekpone, Maria Amparo Núñez-Andrés, Sarah Hoibak, Xavier Vallès
{"title":"中非共和国抗逆转录病毒治疗的保留和失去随访的驱动因素：纵向分析。","authors":"Gaspard Tekpa, Jules Inikoutiyo, Christian Yonli, Celia Noguera, Pierre Prince Lujwiro, Laure Gigout, Aboubacar Hachimou, Sydney Romaric, Raphaël Mabaïlao, Marie Charlotte Banthas, Larissa Bertille Mbia, Paulette Rose Mbay, Kevin Romuald, Alain Sana, Florida Roberte, Laura Moretó-Planas, Eric Goemaere, Calorine Mekiedje, Stella Ouanekpone, Maria Amparo Núñez-Andrés, Sarah Hoibak, Xavier Vallès","doi":"10.1002/jia2.26387","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Introduction</h3>\n \n <p>The retention in care of patients undergoing antiretroviral therapy (ART) is a cornerstone for preventing AIDS-associated morbidity and mortality, as well as further transmission of HIV. Adherence to ART poses particular challenges in conflict-affected settings like the Central African Republic (CAR). The study objective was to estimate the rate of lost-to-follow-up (LTFU) and determine factors associated with LTFU among patients living with HIV under ART in CAR.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A retrospective cohort analysis was conducted using data from patients being managed at 42 representative ART dispensing sites (i.e. management of ≥200 patients) in the seven health regions of CAR which started ART between January 2019 to September 2021 and followed up to December 2021. The outcome of LTFU was defined as a failure of a patient to attend a scheduled ART refill appointment for at least 90 days from the last appointment. Patients were censored at the first LTFU event.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>A total of 6844 patients enrolled in ART care were included in the analysis, of whom 67.5% were females. The mean age (standard deviation) was 35.3 years (10.5). Forty-two per cent (<i>n</i> = 2874/6844) had an LTFU event during the follow-up period. However, 23.2% (<i>n</i> = 666/2874) returned to care after LTFU. Overall retention in antiretroviral care at 12 months was 64.2% (CI 63.0−65.5), which ranged from 76.1% in the capital to 48.2% in the inner country region. Risk factors related to LTFU were being male (adjusted hazard ratio [aHR] 1.33; CI 1.1−1.5), age < 25 (aHR 1.46; CI 1.1−1.9), living in regions outside the capital (aHR 1.83; CI 1.6−2.3) and undernutrition (aHR 1.13; CI 1.0−1.3).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Retention to care in CAR is suboptimal, especially in the inner country. Our results underline the difficulties involved in retaining patients in ART in complex settings, the interplay between poor retention, social unrest, stigma, food insecurity and HIV epidemic control, and the need for tailored programming and interventions like differentiated treatment strategies and complementary food provision.</p>\n </section>\n </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 12","pages":""},"PeriodicalIF":4.6000,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11621234/pdf/","citationCount":"0","resultStr":"{\"title\":\"Retention on antiretroviral therapy and drivers of lost-to-follow up in the Central African Republic: a longitudinal analysis\",\"authors\":\"Gaspard Tekpa, Jules Inikoutiyo, Christian Yonli, Celia Noguera, Pierre Prince Lujwiro, Laure Gigout, Aboubacar Hachimou, Sydney Romaric, Raphaël Mabaïlao, Marie Charlotte Banthas, Larissa Bertille Mbia, Paulette Rose Mbay, Kevin Romuald, Alain Sana, Florida Roberte, Laura Moretó-Planas, Eric Goemaere, Calorine Mekiedje, Stella Ouanekpone, Maria Amparo Núñez-Andrés, Sarah Hoibak, Xavier Vallès\",\"doi\":\"10.1002/jia2.26387\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Introduction</h3>\\n \\n <p>The retention in care of patients undergoing antiretroviral therapy (ART) is a cornerstone for preventing AIDS-associated morbidity and mortality, as well as further transmission of HIV. Adherence to ART poses particular challenges in conflict-affected settings like the Central African Republic (CAR). The study objective was to estimate the rate of lost-to-follow-up (LTFU) and determine factors associated with LTFU among patients living with HIV under ART in CAR.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>A retrospective cohort analysis was conducted using data from patients being managed at 42 representative ART dispensing sites (i.e. management of ≥200 patients) in the seven health regions of CAR which started ART between January 2019 to September 2021 and followed up to December 2021. The outcome of LTFU was defined as a failure of a patient to attend a scheduled ART refill appointment for at least 90 days from the last appointment. Patients were censored at the first LTFU event.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>A total of 6844 patients enrolled in ART care were included in the analysis, of whom 67.5% were females. The mean age (standard deviation) was 35.3 years (10.5). Forty-two per cent (<i>n</i> = 2874/6844) had an LTFU event during the follow-up period. However, 23.2% (<i>n</i> = 666/2874) returned to care after LTFU. Overall retention in antiretroviral care at 12 months was 64.2% (CI 63.0−65.5), which ranged from 76.1% in the capital to 48.2% in the inner country region. Risk factors related to LTFU were being male (adjusted hazard ratio [aHR] 1.33; CI 1.1−1.5), age < 25 (aHR 1.46; CI 1.1−1.9), living in regions outside the capital (aHR 1.83; CI 1.6−2.3) and undernutrition (aHR 1.13; CI 1.0−1.3).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>Retention to care in CAR is suboptimal, especially in the inner country. 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Retention on antiretroviral therapy and drivers of lost-to-follow up in the Central African Republic: a longitudinal analysis
Introduction
The retention in care of patients undergoing antiretroviral therapy (ART) is a cornerstone for preventing AIDS-associated morbidity and mortality, as well as further transmission of HIV. Adherence to ART poses particular challenges in conflict-affected settings like the Central African Republic (CAR). The study objective was to estimate the rate of lost-to-follow-up (LTFU) and determine factors associated with LTFU among patients living with HIV under ART in CAR.
Methods
A retrospective cohort analysis was conducted using data from patients being managed at 42 representative ART dispensing sites (i.e. management of ≥200 patients) in the seven health regions of CAR which started ART between January 2019 to September 2021 and followed up to December 2021. The outcome of LTFU was defined as a failure of a patient to attend a scheduled ART refill appointment for at least 90 days from the last appointment. Patients were censored at the first LTFU event.
Results
A total of 6844 patients enrolled in ART care were included in the analysis, of whom 67.5% were females. The mean age (standard deviation) was 35.3 years (10.5). Forty-two per cent (n = 2874/6844) had an LTFU event during the follow-up period. However, 23.2% (n = 666/2874) returned to care after LTFU. Overall retention in antiretroviral care at 12 months was 64.2% (CI 63.0−65.5), which ranged from 76.1% in the capital to 48.2% in the inner country region. Risk factors related to LTFU were being male (adjusted hazard ratio [aHR] 1.33; CI 1.1−1.5), age < 25 (aHR 1.46; CI 1.1−1.9), living in regions outside the capital (aHR 1.83; CI 1.6−2.3) and undernutrition (aHR 1.13; CI 1.0−1.3).
Conclusions
Retention to care in CAR is suboptimal, especially in the inner country. Our results underline the difficulties involved in retaining patients in ART in complex settings, the interplay between poor retention, social unrest, stigma, food insecurity and HIV epidemic control, and the need for tailored programming and interventions like differentiated treatment strategies and complementary food provision.
期刊介绍：
The Journal of the International AIDS Society (JIAS) is a peer-reviewed and Open Access journal for the generation and dissemination of evidence from a wide range of disciplines: basic and biomedical sciences; behavioural sciences; epidemiology; clinical sciences; health economics and health policy; operations research and implementation sciences; and social sciences and humanities. Submission of HIV research carried out in low- and middle-income countries is strongly encouraged.
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