Predictors of lost to follow-up in a "test and treat" programme among adult women with high-risk sexual behavior in Kampala, Uganda

Background Immediate uptake of antiretroviral therapy (ART) after an HIV-positive diagnosis (Test and Treat) is now being implemented in Uganda. Data are limited on lost to follow-up (LTFU) in high-risk cohorts that have initiated 'Test and Treat'. We describe LTFU in a cohort of women of...

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Veröffentlicht in:BMC public health 2020-03, Vol.20 (1), p.353-353, Article 353
Hauptverfasser: Kamacooko, Onesmus, Mayanja, Yunia, Bagiire, Daniel, Namale, Gertrude, Hansen, Christian Holm, Seeley, Janet
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container_end_page 353
container_issue 1
container_start_page 353
container_title BMC public health
container_volume 20
creator Kamacooko, Onesmus
Mayanja, Yunia
Bagiire, Daniel
Namale, Gertrude
Hansen, Christian Holm
Seeley, Janet
description Background Immediate uptake of antiretroviral therapy (ART) after an HIV-positive diagnosis (Test and Treat) is now being implemented in Uganda. Data are limited on lost to follow-up (LTFU) in high-risk cohorts that have initiated 'Test and Treat'. We describe LTFU in a cohort of women of high-risk sexual behaviour who initiated ART under "Test and Treat". Methods We performed a retrospective cohort study of participant records at the Good Health for Women Project (GHWP) clinic, a clinic in Kampala for women at high-risk of HIV-infection. We included HIV positive women >= 18 years who initiated ART at GHWP between August 2014 and March 2018. We defined LTFU as not taking an ART refill for >= 3 months from the last clinic appointment among those not registered as dead or transferred to another clinic. We used the Kaplan-Meier technique to estimate time to LTFU after ART initiation. Predictors of LTFU were assessed using a multivariable Cox proportional hazards model. Results The mean (+/- SD) age of the 293 study participants was 30.3 (+/- 6.5) years, with 274 (94%) reporting paid sex while 38 (13%) had never tested for HIV before enrolment into GHWP. LTFU within the first year of ART initiation was 16% and the incidence of LTFU was estimated at 12.7 per 100 person-years (95%CI 9.90-16.3). In multivariable analysis, participants who reported sex work as their main job at ART initiation (Adjusted Hazards Ratio [aHR] =1.95, 95%CI 1.10-3.45), having baseline WHO clinical stage III or IV (aHR = 2.75, 95% CI 1.30-5.79) were more likely to be LTFU. Conclusion LTFU in this cohort is high. Follow up strategies are required to support women on Test and Treat to remain on treatment, especially those who engage in sex work and those who initiate ART at a later stage of disease.
doi_str_mv 10.1186/s12889-020-8439-9
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Data are limited on lost to follow-up (LTFU) in high-risk cohorts that have initiated 'Test and Treat'. We describe LTFU in a cohort of women of high-risk sexual behaviour who initiated ART under "Test and Treat". Methods We performed a retrospective cohort study of participant records at the Good Health for Women Project (GHWP) clinic, a clinic in Kampala for women at high-risk of HIV-infection. We included HIV positive women &gt;= 18 years who initiated ART at GHWP between August 2014 and March 2018. We defined LTFU as not taking an ART refill for &gt;= 3 months from the last clinic appointment among those not registered as dead or transferred to another clinic. We used the Kaplan-Meier technique to estimate time to LTFU after ART initiation. Predictors of LTFU were assessed using a multivariable Cox proportional hazards model. Results The mean (+/- SD) age of the 293 study participants was 30.3 (+/- 6.5) years, with 274 (94%) reporting paid sex while 38 (13%) had never tested for HIV before enrolment into GHWP. LTFU within the first year of ART initiation was 16% and the incidence of LTFU was estimated at 12.7 per 100 person-years (95%CI 9.90-16.3). In multivariable analysis, participants who reported sex work as their main job at ART initiation (Adjusted Hazards Ratio [aHR] =1.95, 95%CI 1.10-3.45), having baseline WHO clinical stage III or IV (aHR = 2.75, 95% CI 1.30-5.79) were more likely to be LTFU. Conclusion LTFU in this cohort is high. Follow up strategies are required to support women on Test and Treat to remain on treatment, especially those who engage in sex work and those who initiate ART at a later stage of disease.</description><identifier>ISSN: 1471-2458</identifier><identifier>EISSN: 1471-2458</identifier><identifier>DOI: 10.1186/s12889-020-8439-9</identifier><identifier>PMID: 32183759</identifier><language>eng</language><publisher>LONDON: Springer Nature</publisher><subject>Adult ; Adults ; Anti-Retroviral Agents - therapeutic use ; Antiretroviral agents ; Antiretroviral therapy ; Counseling ; Diseases ; Dosage and administration ; Drug therapy ; Female ; Hazard assessment ; Health ; Health aspects ; Health hazards ; Health risks ; Highly active antiretroviral therapy ; HIV ; HIV infections ; HIV Infections - diagnosis ; HIV Infections - drug therapy ; HIV Infections - epidemiology ; HIV tests ; Human immunodeficiency virus ; Humans ; Infections ; Life Sciences &amp; Biomedicine ; Loss to follow-up; sub-Saharan Africa ; Lost to Follow-Up ; Medication Adherence - statistics &amp; numerical data ; Prevention ; Program Evaluation ; Proportional Hazards Models ; Public health ; Public, Environmental &amp; Occupational Health ; Retention ; Retrospective Studies ; Risk ; Risk taking ; Science &amp; Technology ; Sex ; Sex Work - statistics &amp; numerical data ; Sexual behavior ; Sexually transmitted diseases ; Statistical models ; STD ; Studies ; Time ; Uganda - epidemiology ; Universal test and treat ; Women ; Women at high-risk ; Women's health</subject><ispartof>BMC public health, 2020-03, Vol.20 (1), p.353-353, Article 353</ispartof><rights>COPYRIGHT 2020 BioMed Central Ltd.</rights><rights>2020. 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Data are limited on lost to follow-up (LTFU) in high-risk cohorts that have initiated 'Test and Treat'. We describe LTFU in a cohort of women of high-risk sexual behaviour who initiated ART under "Test and Treat". Methods We performed a retrospective cohort study of participant records at the Good Health for Women Project (GHWP) clinic, a clinic in Kampala for women at high-risk of HIV-infection. We included HIV positive women &gt;= 18 years who initiated ART at GHWP between August 2014 and March 2018. We defined LTFU as not taking an ART refill for &gt;= 3 months from the last clinic appointment among those not registered as dead or transferred to another clinic. We used the Kaplan-Meier technique to estimate time to LTFU after ART initiation. Predictors of LTFU were assessed using a multivariable Cox proportional hazards model. Results The mean (+/- SD) age of the 293 study participants was 30.3 (+/- 6.5) years, with 274 (94%) reporting paid sex while 38 (13%) had never tested for HIV before enrolment into GHWP. LTFU within the first year of ART initiation was 16% and the incidence of LTFU was estimated at 12.7 per 100 person-years (95%CI 9.90-16.3). In multivariable analysis, participants who reported sex work as their main job at ART initiation (Adjusted Hazards Ratio [aHR] =1.95, 95%CI 1.10-3.45), having baseline WHO clinical stage III or IV (aHR = 2.75, 95% CI 1.30-5.79) were more likely to be LTFU. Conclusion LTFU in this cohort is high. Follow up strategies are required to support women on Test and Treat to remain on treatment, especially those who engage in sex work and those who initiate ART at a later stage of disease.</description><subject>Adult</subject><subject>Adults</subject><subject>Anti-Retroviral Agents - therapeutic use</subject><subject>Antiretroviral agents</subject><subject>Antiretroviral therapy</subject><subject>Counseling</subject><subject>Diseases</subject><subject>Dosage and administration</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Hazard assessment</subject><subject>Health</subject><subject>Health aspects</subject><subject>Health hazards</subject><subject>Health risks</subject><subject>Highly active antiretroviral therapy</subject><subject>HIV</subject><subject>HIV infections</subject><subject>HIV Infections - diagnosis</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - epidemiology</subject><subject>HIV tests</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Infections</subject><subject>Life Sciences &amp; Biomedicine</subject><subject>Loss to follow-up; sub-Saharan Africa</subject><subject>Lost to Follow-Up</subject><subject>Medication Adherence - statistics &amp; numerical data</subject><subject>Prevention</subject><subject>Program Evaluation</subject><subject>Proportional Hazards Models</subject><subject>Public health</subject><subject>Public, Environmental &amp; Occupational Health</subject><subject>Retention</subject><subject>Retrospective Studies</subject><subject>Risk</subject><subject>Risk taking</subject><subject>Science &amp; Technology</subject><subject>Sex</subject><subject>Sex Work - statistics &amp; numerical data</subject><subject>Sexual behavior</subject><subject>Sexually transmitted diseases</subject><subject>Statistical models</subject><subject>STD</subject><subject>Studies</subject><subject>Time</subject><subject>Uganda - epidemiology</subject><subject>Universal test and treat</subject><subject>Women</subject><subject>Women at high-risk</subject><subject>Women's health</subject><issn>1471-2458</issn><issn>1471-2458</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>AOWDO</sourceid><sourceid>ARHDP</sourceid><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>eNqNkk1v1DAQhiMEoqXwA7ggq1yQIMWfsXNBqlZ8VFSCAz1bjmNnXRJ7aztdOPPHcdiytIgD8sHW-JnXM-O3qp4ieIKQaF4nhIVoa4hhLShp6_ZedYgoRzWmTNy_dT6oHqV0CSHiguGH1QHBSBDO2sPqx-doeqdziAkEC8aQMsgB2DCOYVvPG-A8UOA4mxJXvgc5GpWPwSaGIappMkBNwQ9A9fOYwTZMxoOty2uwdsO6ji59Bcl8m9UIOrNW1y7ERfCjmjZqVK_AxVA01ePqgVVjMk9u9qPq4t3bL6sP9fmn92er0_Naswbmumkp44wLrDmEjVDCti3Dqu-ggFTorodEMUhZQzmDjbGE6hazntiuU7aDLTmqzna6fVCXchPdpOJ3GZSTvwIhDlLF7PRopMYN6UQrILOWGsU6whrSWC16KHCHbNF6s9PazN1kem18jmq8I3r3xru1HMK15JCXqpdiXtwIxHA1l_HKySVtxlF5E-YkMeHlb3nT8oI-_wu9DHP0ZVQL1SKKMW3_UIMqDThvQ3lXL6LytEGCE0EFKdTJP6iyejM5HbyxrsTvJKBdgo4hpWjsvkcE5eJCuXOhLC6UiwvlUsqz28PZZ_y2XQFe7oCt6YJN2hmvzR6DEDKMCOG0nCAutPh_euWyyi74VZh9Jj8BLyj3SA</recordid><startdate>20200318</startdate><enddate>20200318</enddate><creator>Kamacooko, Onesmus</creator><creator>Mayanja, Yunia</creator><creator>Bagiire, Daniel</creator><creator>Namale, Gertrude</creator><creator>Hansen, Christian Holm</creator><creator>Seeley, Janet</creator><general>Springer Nature</general><general>BioMed Central Ltd</general><general>BioMed Central</general><general>BMC</general><scope>17B</scope><scope>AOWDO</scope><scope>ARHDP</scope><scope>BLEPL</scope><scope>DTL</scope><scope>DVR</scope><scope>EGQ</scope><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>3V.</scope><scope>7T2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FE</scope><scope>8FG</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>L6V</scope><scope>M0S</scope><scope>M1P</scope><scope>M7S</scope><scope>PATMY</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-0583-5272</orcidid><orcidid>https://orcid.org/0000-0002-5949-0097</orcidid><orcidid>https://orcid.org/0000-0003-2048-8990</orcidid><orcidid>https://orcid.org/0000-0002-0414-1818</orcidid></search><sort><creationdate>20200318</creationdate><title>Predictors of lost to follow-up in a "test and treat" programme among adult women with high-risk sexual behavior in Kampala, Uganda</title><author>Kamacooko, Onesmus ; 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Data are limited on lost to follow-up (LTFU) in high-risk cohorts that have initiated 'Test and Treat'. We describe LTFU in a cohort of women of high-risk sexual behaviour who initiated ART under "Test and Treat". Methods We performed a retrospective cohort study of participant records at the Good Health for Women Project (GHWP) clinic, a clinic in Kampala for women at high-risk of HIV-infection. We included HIV positive women &gt;= 18 years who initiated ART at GHWP between August 2014 and March 2018. We defined LTFU as not taking an ART refill for &gt;= 3 months from the last clinic appointment among those not registered as dead or transferred to another clinic. We used the Kaplan-Meier technique to estimate time to LTFU after ART initiation. Predictors of LTFU were assessed using a multivariable Cox proportional hazards model. Results The mean (+/- SD) age of the 293 study participants was 30.3 (+/- 6.5) years, with 274 (94%) reporting paid sex while 38 (13%) had never tested for HIV before enrolment into GHWP. LTFU within the first year of ART initiation was 16% and the incidence of LTFU was estimated at 12.7 per 100 person-years (95%CI 9.90-16.3). In multivariable analysis, participants who reported sex work as their main job at ART initiation (Adjusted Hazards Ratio [aHR] =1.95, 95%CI 1.10-3.45), having baseline WHO clinical stage III or IV (aHR = 2.75, 95% CI 1.30-5.79) were more likely to be LTFU. Conclusion LTFU in this cohort is high. Follow up strategies are required to support women on Test and Treat to remain on treatment, especially those who engage in sex work and those who initiate ART at a later stage of disease.</abstract><cop>LONDON</cop><pub>Springer Nature</pub><pmid>32183759</pmid><doi>10.1186/s12889-020-8439-9</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-0583-5272</orcidid><orcidid>https://orcid.org/0000-0002-5949-0097</orcidid><orcidid>https://orcid.org/0000-0003-2048-8990</orcidid><orcidid>https://orcid.org/0000-0002-0414-1818</orcidid><oa>free_for_read</oa></addata></record>
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subjects Adult
Adults
Anti-Retroviral Agents - therapeutic use
Antiretroviral agents
Antiretroviral therapy
Counseling
Diseases
Dosage and administration
Drug therapy
Female
Hazard assessment
Health
Health aspects
Health hazards
Health risks
Highly active antiretroviral therapy
HIV
HIV infections
HIV Infections - diagnosis
HIV Infections - drug therapy
HIV Infections - epidemiology
HIV tests
Human immunodeficiency virus
Humans
Infections
Life Sciences & Biomedicine
Loss to follow-up
sub-Saharan Africa
Lost to Follow-Up
Medication Adherence - statistics & numerical data
Prevention
Program Evaluation
Proportional Hazards Models
Public health
Public, Environmental & Occupational Health
Retention
Retrospective Studies
Risk
Risk taking
Science & Technology
Sex
Sex Work - statistics & numerical data
Sexual behavior
Sexually transmitted diseases
Statistical models
STD
Studies
Time
Uganda - epidemiology
Universal test and treat
Women
Women at high-risk
Women's health
title Predictors of lost to follow-up in a "test and treat" programme among adult women with high-risk sexual behavior in Kampala, Uganda
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