Prevalence, trend and risk factors for antiretroviral therapy discontinuation among HIV-infected adults in Ethiopia in 2003-2015
It is well acknowledged that antiretroviral therapy (ART) discontinuation hampers the progress towards achieving the UNAIDS treatment targets that aim to treat 90% of HIV diagnosed patients and achieve viral suppression for 90% of those on treatment. Nevertheless, the magnitude, trend and risk facto...
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| description | It is well acknowledged that antiretroviral therapy (ART) discontinuation hampers the progress towards achieving the UNAIDS treatment targets that aim to treat 90% of HIV diagnosed patients and achieve viral suppression for 90% of those on treatment. Nevertheless, the magnitude, trend and risk factors for ART discontinuation have not been explored extensively. We carried out a retrospective data analysis to assess prevalence, trend and risk factors for ART discontinuation among adults in Southwest Ethiopia.
12 years retrospective cohort analysis was performed with 4900 HIV-infected adult patients between 21 June 2003 and 15 March 2015 registered at the ART clinic at Jimma University Teaching Hospital. ART discontinuation could be loss to follow-up, defaulting and/or stopping medication while remaining in care. Because data for 2003 and 2015 were incomplete, the 10 years data were used to describe trends for ART discontinuation using a line graph. We used binary logistic regression to identify factors that were correlated with ART discontinuation. To handle missing data, we applied multiple imputations assuming missing at random pattern.
In total, 4900 adult patients enrolled on ART, of whom 1090 (22.3%) had discontinued, 954 (19.5%) had transferred out, 300 (6.1%) had died, 2517 (51.4%) were alive and on ART, and the remaining 39 (0.8%) had unknown outcome status. The trend of ART discontinuation showed an upward direction in the recent times and reached a peak, accounting for a magnitude of 10%, in 2004 and 2005. Being a female (AOR = 2.1, 95%CI: 1.7-2.8), having an immunological failure (AOR = 2.3, 1.9-8.2), having tuberculosis/HIV co-infection (AOR = 1.5, 1.1-2.1) and no previous history of HIV testing (AOR = 1.8, 1.4-2.9) were the risk factors for ART discontinuation.
One out of five adults had discontinued from ART, and the trend of ART discontinuation increased recently. Discontinued adults were more likely to be females, tuberculosis/HIV co-infected, with immunological failure and no history of HIV testing. Therefore, it is vital to implement effective programs such as community ART distribution and linkage-case-management to enhance ART linkage and retention. |
| doi_str_mv | 10.1371/journal.pone.0179533 |
| format | Article |
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12 years retrospective cohort analysis was performed with 4900 HIV-infected adult patients between 21 June 2003 and 15 March 2015 registered at the ART clinic at Jimma University Teaching Hospital. ART discontinuation could be loss to follow-up, defaulting and/or stopping medication while remaining in care. Because data for 2003 and 2015 were incomplete, the 10 years data were used to describe trends for ART discontinuation using a line graph. We used binary logistic regression to identify factors that were correlated with ART discontinuation. To handle missing data, we applied multiple imputations assuming missing at random pattern.
In total, 4900 adult patients enrolled on ART, of whom 1090 (22.3%) had discontinued, 954 (19.5%) had transferred out, 300 (6.1%) had died, 2517 (51.4%) were alive and on ART, and the remaining 39 (0.8%) had unknown outcome status. The trend of ART discontinuation showed an upward direction in the recent times and reached a peak, accounting for a magnitude of 10%, in 2004 and 2005. Being a female (AOR = 2.1, 95%CI: 1.7-2.8), having an immunological failure (AOR = 2.3, 1.9-8.2), having tuberculosis/HIV co-infection (AOR = 1.5, 1.1-2.1) and no previous history of HIV testing (AOR = 1.8, 1.4-2.9) were the risk factors for ART discontinuation.
One out of five adults had discontinued from ART, and the trend of ART discontinuation increased recently. Discontinued adults were more likely to be females, tuberculosis/HIV co-infected, with immunological failure and no history of HIV testing. Therefore, it is vital to implement effective programs such as community ART distribution and linkage-case-management to enhance ART linkage and retention.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0179533</identifier><identifier>PMID: 28622361</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Acquired immune deficiency syndrome ; Adolescent ; Adult ; Adults ; Aged ; Aged, 80 and over ; AIDS ; Anti-Retroviral Agents - administration & dosage ; Antiretroviral agents ; Antiretroviral drugs ; Antiretroviral therapy ; Biology and Life Sciences ; Data analysis ; Data processing ; Drug therapy ; Drugs ; Ethiopia ; Female ; Females ; Health aspects ; Highly active antiretroviral therapy ; HIV ; HIV infections ; HIV Infections - drug therapy ; HIV Infections - epidemiology ; Human immunodeficiency virus ; Humans ; Immunology ; Infections ; Male ; Medical diagnosis ; Medication Adherence ; Medicine and Health Sciences ; Middle Aged ; Missing data ; Patient outcomes ; Patients ; People and Places ; Prevalence ; Regression analysis ; Retrospective Studies ; Risk analysis ; Risk Factors ; Sex Factors ; Therapy ; Tuberculosis</subject><ispartof>PloS one, 2017-06, Vol.12 (6), p.e0179533</ispartof><rights>COPYRIGHT 2017 Public Library of Science</rights><rights>2017 Gesesew et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2017 Gesesew et al 2017 Gesesew et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-1014f5a5a0eeb567ebe219c7d240d687ff9d595cafd803182eeb7809f701ada43</citedby><cites>FETCH-LOGICAL-c692t-1014f5a5a0eeb567ebe219c7d240d687ff9d595cafd803182eeb7809f701ada43</cites><orcidid>0000-0002-3531-4400</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473588/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5473588/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28622361$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Maga, Giovanni</contributor><creatorcontrib>Gesesew, Hailay Abrha</creatorcontrib><creatorcontrib>Ward, Paul</creatorcontrib><creatorcontrib>Woldemichael, Kifle</creatorcontrib><creatorcontrib>Mwanri, Lillian</creatorcontrib><title>Prevalence, trend and risk factors for antiretroviral therapy discontinuation among HIV-infected adults in Ethiopia in 2003-2015</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>It is well acknowledged that antiretroviral therapy (ART) discontinuation hampers the progress towards achieving the UNAIDS treatment targets that aim to treat 90% of HIV diagnosed patients and achieve viral suppression for 90% of those on treatment. Nevertheless, the magnitude, trend and risk factors for ART discontinuation have not been explored extensively. We carried out a retrospective data analysis to assess prevalence, trend and risk factors for ART discontinuation among adults in Southwest Ethiopia.
12 years retrospective cohort analysis was performed with 4900 HIV-infected adult patients between 21 June 2003 and 15 March 2015 registered at the ART clinic at Jimma University Teaching Hospital. ART discontinuation could be loss to follow-up, defaulting and/or stopping medication while remaining in care. Because data for 2003 and 2015 were incomplete, the 10 years data were used to describe trends for ART discontinuation using a line graph. We used binary logistic regression to identify factors that were correlated with ART discontinuation. To handle missing data, we applied multiple imputations assuming missing at random pattern.
In total, 4900 adult patients enrolled on ART, of whom 1090 (22.3%) had discontinued, 954 (19.5%) had transferred out, 300 (6.1%) had died, 2517 (51.4%) were alive and on ART, and the remaining 39 (0.8%) had unknown outcome status. The trend of ART discontinuation showed an upward direction in the recent times and reached a peak, accounting for a magnitude of 10%, in 2004 and 2005. Being a female (AOR = 2.1, 95%CI: 1.7-2.8), having an immunological failure (AOR = 2.3, 1.9-8.2), having tuberculosis/HIV co-infection (AOR = 1.5, 1.1-2.1) and no previous history of HIV testing (AOR = 1.8, 1.4-2.9) were the risk factors for ART discontinuation.
One out of five adults had discontinued from ART, and the trend of ART discontinuation increased recently. Discontinued adults were more likely to be females, tuberculosis/HIV co-infected, with immunological failure and no history of HIV testing. Therefore, it is vital to implement effective programs such as community ART distribution and linkage-case-management to enhance ART linkage and retention.</description><subject>Acquired immune deficiency syndrome</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Adults</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>AIDS</subject><subject>Anti-Retroviral Agents - administration & dosage</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral drugs</subject><subject>Antiretroviral therapy</subject><subject>Biology and Life Sciences</subject><subject>Data analysis</subject><subject>Data processing</subject><subject>Drug therapy</subject><subject>Drugs</subject><subject>Ethiopia</subject><subject>Female</subject><subject>Females</subject><subject>Health aspects</subject><subject>Highly active antiretroviral therapy</subject><subject>HIV</subject><subject>HIV infections</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - epidemiology</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Immunology</subject><subject>Infections</subject><subject>Male</subject><subject>Medical diagnosis</subject><subject>Medication Adherence</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Missing data</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>People and Places</subject><subject>Prevalence</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Risk analysis</subject><subject>Risk Factors</subject><subject>Sex Factors</subject><subject>Therapy</subject><subject>Tuberculosis</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNqNk12L1DAUhoso7rr6D0QLgijYMR9t0t4Iy7K6AwsrfuxtyCQnMxk7zZikg3vnTzd1ustU9kJKaTh5znvS9-Rk2XOMZphy_H7tet_JdrZ1HcwQ5k1F6YPsGDeUFIwg-vBgfZQ9CWGNUEVrxh5nR6RmhFCGj7Pfnz3sZAudgnd59NDpXKbX2_AjN1JF50NunE_BaD1E73bWyzaPK_Bye5NrG5RLW10vo3VdLjeuW-YX8-vCdgZUhCSn-zaG3Hb5eVxZt7VyWBOEaEEQrp5mj4xsAzwbvyfZ94_n384uisurT_Oz08tCsYbEAiNcmkpWEgEsKsZhAQQ3imtSIs1qbkyjq6ZS0ugaUVyThPEaNYYjLLUs6Un2cq-7bV0Qo3lB4AajssaoJomY7wnt5Fpsvd1IfyOctOJvwPmlkD5a1YIwXGkmNWMLWpYlWdQap0o1VgaA0RIlrQ9jtX6xAa2gi8m2ieh0p7MrsXQ7UZWcVnWdBN6MAt797CFEsUlWQ9vKDly_PzdvOCE8oa_-Qe__u5Fapm6L1B2X6qpBVJyWTcURQ2WVqNk9VHo0bGzqNBib4pOEt5OE4TbAr7iUfQhi_vXL_7NX11P29QG7AtnGVXBtP9yyMAXLPai8C8GDuTMZIzEMyq0bYhgUMQ5KSntx2KC7pNvJoH8AydsN_A</recordid><startdate>20170616</startdate><enddate>20170616</enddate><creator>Gesesew, Hailay Abrha</creator><creator>Ward, Paul</creator><creator>Woldemichael, Kifle</creator><creator>Mwanri, Lillian</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-3531-4400</orcidid></search><sort><creationdate>20170616</creationdate><title>Prevalence, trend and risk factors for antiretroviral therapy discontinuation among HIV-infected adults in Ethiopia in 2003-2015</title><author>Gesesew, Hailay Abrha ; Ward, Paul ; Woldemichael, Kifle ; Mwanri, Lillian</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-1014f5a5a0eeb567ebe219c7d240d687ff9d595cafd803182eeb7809f701ada43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Adults</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>AIDS</topic><topic>Anti-Retroviral Agents - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gesesew, Hailay Abrha</au><au>Ward, Paul</au><au>Woldemichael, Kifle</au><au>Mwanri, Lillian</au><au>Maga, Giovanni</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevalence, trend and risk factors for antiretroviral therapy discontinuation among HIV-infected adults in Ethiopia in 2003-2015</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2017-06-16</date><risdate>2017</risdate><volume>12</volume><issue>6</issue><spage>e0179533</spage><pages>e0179533-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>It is well acknowledged that antiretroviral therapy (ART) discontinuation hampers the progress towards achieving the UNAIDS treatment targets that aim to treat 90% of HIV diagnosed patients and achieve viral suppression for 90% of those on treatment. Nevertheless, the magnitude, trend and risk factors for ART discontinuation have not been explored extensively. We carried out a retrospective data analysis to assess prevalence, trend and risk factors for ART discontinuation among adults in Southwest Ethiopia.
12 years retrospective cohort analysis was performed with 4900 HIV-infected adult patients between 21 June 2003 and 15 March 2015 registered at the ART clinic at Jimma University Teaching Hospital. ART discontinuation could be loss to follow-up, defaulting and/or stopping medication while remaining in care. Because data for 2003 and 2015 were incomplete, the 10 years data were used to describe trends for ART discontinuation using a line graph. We used binary logistic regression to identify factors that were correlated with ART discontinuation. To handle missing data, we applied multiple imputations assuming missing at random pattern.
In total, 4900 adult patients enrolled on ART, of whom 1090 (22.3%) had discontinued, 954 (19.5%) had transferred out, 300 (6.1%) had died, 2517 (51.4%) were alive and on ART, and the remaining 39 (0.8%) had unknown outcome status. The trend of ART discontinuation showed an upward direction in the recent times and reached a peak, accounting for a magnitude of 10%, in 2004 and 2005. Being a female (AOR = 2.1, 95%CI: 1.7-2.8), having an immunological failure (AOR = 2.3, 1.9-8.2), having tuberculosis/HIV co-infection (AOR = 1.5, 1.1-2.1) and no previous history of HIV testing (AOR = 1.8, 1.4-2.9) were the risk factors for ART discontinuation.
One out of five adults had discontinued from ART, and the trend of ART discontinuation increased recently. Discontinued adults were more likely to be females, tuberculosis/HIV co-infected, with immunological failure and no history of HIV testing. Therefore, it is vital to implement effective programs such as community ART distribution and linkage-case-management to enhance ART linkage and retention.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>28622361</pmid><doi>10.1371/journal.pone.0179533</doi><tpages>e0179533</tpages><orcidid>https://orcid.org/0000-0002-3531-4400</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | PloS one, 2017-06, Vol.12 (6), p.e0179533 |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Acquired immune deficiency syndrome Adolescent Adult Adults Aged Aged, 80 and over AIDS Anti-Retroviral Agents - administration & dosage Antiretroviral agents Antiretroviral drugs Antiretroviral therapy Biology and Life Sciences Data analysis Data processing Drug therapy Drugs Ethiopia Female Females Health aspects Highly active antiretroviral therapy HIV HIV infections HIV Infections - drug therapy HIV Infections - epidemiology Human immunodeficiency virus Humans Immunology Infections Male Medical diagnosis Medication Adherence Medicine and Health Sciences Middle Aged Missing data Patient outcomes Patients People and Places Prevalence Regression analysis Retrospective Studies Risk analysis Risk Factors Sex Factors Therapy Tuberculosis |
| title | Prevalence, trend and risk factors for antiretroviral therapy discontinuation among HIV-infected adults in Ethiopia in 2003-2015 |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-22T03%3A50%3A56IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Prevalence,%20trend%20and%20risk%20factors%20for%20antiretroviral%20therapy%20discontinuation%20among%20HIV-infected%20adults%20in%20Ethiopia%20in%202003-2015&rft.jtitle=PloS%20one&rft.au=Gesesew,%20Hailay%20Abrha&rft.date=2017-06-16&rft.volume=12&rft.issue=6&rft.spage=e0179533&rft.pages=e0179533-&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0179533&rft_dat=%3Cgale_plos_%3EA495706045%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1910481082&rft_id=info:pmid/28622361&rft_galeid=A495706045&rft_doaj_id=oai_doaj_org_article_f7cd6ad66b34442b8d19f781cfee6340&rfr_iscdi=true |