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Analysis of retention in care for people living with HIV in Togo: results of a survey conducted in 2021Introduction. The aim of our study was to analyze retention in care and survival at 12, 24, and 36 months among people living with HIV (PLWH) on antiretroviral therapy (ART).Methods. This is a retrospective cross-sectional analysis of a cohort of PLWH aged 15 years and older who started ART. Purposive sampling was used, taking into account the activities of different health centers and budgetary constraints (quantitative approach). In-depth individual interviews and focus groups were also conducted (qualitative approach).Results. During the study period, 2,100 HIV-infected patients were enrolled. The median age of patients was 44 years (interquartile range (IQR) [36-51]), with a statistically significant difference according to sex (pConclusion. Our study, conducted during the Covid-19 pandemic, shows acceptable retention rates in care for PLWH. These results make possible to propose solutions to improve the care program in the country: the harmonization of procedures for tracing PLWH with the implementation of their active search (with the help of community mediators) and the dispensing of ART to PLWH for three or six months.Analyse de la rétention dans les soins des personnes vivant avec le VIH au Togo: résultats d’une enquête menée en 2021Introduction. Le but de notre étude était d’analyser la rétention dans les soins des personnes vivant avec le VIH (PVVIH) sous antirétroviraux (ARV), et leur survie à 12, 24 et 36 mois.Méthodes. Il s’agit d’une analyse transversale rétrospective d’une cohorte de PVVIH âgées de 15 ans et plus qui ont initié un traitement par ARV (TARV). Un échantillonnage raisonné a permis de prendre en compte l’activité des différents centres de soins et les contraintes budgétaires (approche quantitative). Y ont été associés des entretiens individuels approfondis et des focus groups (approche qualitative).Résultats. Durant la période d’étude, 2 100 patients infectés par le VIH ont été inclus. L’âge médian des patients était de 44 ans (intervalle interquartile (IIQ) [36-51]) avec une différence statistiquement significative selon le sexe (pConclusion. Notre étude réalisée dans la période de la pandémie de Covid-19, montre des taux acceptables de rétention dans les soins des PVVIH. Ces résultats ont permis de proposer des approches de solutions pour améliorer le programme de prise en charge dans le pays : l’harmonisation des procédures de relance des patients PDV avec la mise en place de leur recherche active (avec l’aide des médiateurs communautaires) ; la dispensation pour trois ou six mois des médicaments ARV aux PVVIH.

The risk of developing AIDS is elevated not only among those with a late HIV diagnosis but also among those lost to care (LTC). The aims were to address the risk of becoming LTC and of clinical progression in LTC patients who re-enter care. Patients were defined as LTC if they had no visit for ≥ 18 months. Of these, persons with subsequent visits were defined as re-engaged in care (RIC). Factors associated with becoming LTC and RIC were investigated. The risk of disease progression was estimated by comparing RIC with patients continuously followed. Over 11,285 individuals included, 3962 became LTC, and of these, 1062 were RIC. Older age, presentation with AIDS and with higher HIV-RNA were associated with a reduced risk of LTC. In contrast, lower education level, irregular job, being an immigrant and injecting-drug user were associated with an increased LTC probability. Moreover, RIC with HIV-RNA > 200 copies/mL at the re-entry had a higher risk of clinical progression, while those with HIV-RNA ≤ 200 copies/mL had a higher risk of only non-AIDS progression. Patients re-entering care after being LTC appeared to be at higher risk of clinical progression than those continuously in care. Active strategies for re-engagement in care should be promoted.

Les perdus de vue (PDV) sont toute personne incluse dans un programme et dont on est sans nouvelles depuis six mois. L'objectif de cette étude est de fournir une description objective du problème des malades PDV au service de radiothérapie à l'Institut National d'Oncologie (INO), elle permet d’étudier l'impact des facteurs socio-économiques, démographiques et ceux liés à la maladie entraînant l'abandon du traitement par le patient. Nous avons réalisé une étude rétrospective de 77 patients PDV parmi 2254 patient admis à l'INO du premier janvier au 31 décembre 2011 pour traitement par radiothérapie. La présente analyse a mis en évidence que les taux d'abandon sont associés à des facteurs liés à la maladie et qu’à la fois le patient et le médecin doivent être formés et être conscients de la façon dont les stades avancés de la maladie, le mauvais statut de performance ainsi que la combinaison des autres problèmes de santé peuvent suffisamment conduire le patient à l'abandon du traitement.

Objective: Familial Mediterranean fever (FMF), which is common in countries neighbouring the Mediterranean, requires regular follow-up like other chronic inflammatory rheumatological diseases. Deficiencies in the treatment and follow-up of the disease may result in significant morbidity.In this study, we investigated the reasons for non-follow-up of FMF patients and the clinical characteristics of these patients. Methods: FMF patients who had not attended rheumatology control for more than 1 year were included in this study. Patients were telephoned and asked the reasons of lost to follow-up. Clinical and demographic characteristics of the patients were recorded. Modified Morinsky scale (MMS)-motivation and MMS-knowledge level questionnaires were applied for treatment compliance. Comparison was made between the patients with no follow-up and those with follow-up at an external centre. Comparison of the patient groups with follow-up and those without follow-up was made. P<0.05 was considered statistically significant. Results: It was learnt that of the 176 patients who could be contacted by phone, 74 (42.1%) patients were followed-up in external centres and 93 patients were lost to follow-up. Most of the patients lost to follow-up were university graduates (48.1%) and high school graduates (31.2%). The most common reasons of lost to follow-up were negligence (28%) and failure to find an appointment (25.8%). The variables of MMS-motivation, MMS-knowledge level and informing patients about the need for follow-up at diagnosis had a significant relationship with non-follow-up (p<0.05). Conclusion: The fact that “negligence” was found to be the most common reason of lost to follow-up despite the high educational status of FMF patients revealed the importance of informing even educated patients about the necessity of follow-up. This was supported by the fact that the MMS-motivation and MMS-knowledge level scores were low in patients lost to follow-up. In addition, setting the green list registrations as indefinite will reduce patients’ loss of follow-up.

Background: Although cohort members tend to be healthy and affluent compared with the whole population, some studies indicate this does not bias certain exposure-outcome associations. It is less clear whether this holds when socioeconomic position (SEP) is the exposure of interest. Methods: As an illustrative example, we use data from the Avon Longitudinal Study of Parents and Children. We calculate estimates of maternal education inequalities in outcomes for which data are available on almost the whole cohort (birth weight and length, breast-feeding, preterm birth, maternal obesity, smoking during pregnancy, educational attainment). These are calculated for the full cohort (n~12,000) and in restricted subsamples defined by continued participation at age 10 years (n~7,000) and age 15 years (n~5,000). Results: Loss to follow-up was related both to SEP and outcomes. For each outcome, loss to follow-up was associated with underestimation of inequality, which increased as participation rates decreased (eg, mean birth-weight difference between highest and lowest SEP was 116 g [95% confidence interval = 78 to 153] in the full sample and 93 g [45 to 141] and 62 g [5 to 119] in those attending at ages 10 and 15 years, respectively). Conclusions: Considerable attrition from cohort studies may result in biased estimates of socioeconomic inequalities, and the degree of bias may worsen as participation rates decrease. However, even with considerable attrition (>50%), qualitative conclusions about the direction and approximate magnitude of inequalities did not change among most of our examples. The appropriate analysis approaches to alleviate bias depend on the missingness mechanism.

Introduction We assessed mortality and losses to follow‐up (LTFU) during adolescence in routine care settings in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. Methods Cohorts in the Asia‐Pacific, the Caribbean, Central, and South America, and sub‐Saharan Africa (Central, East, Southern, West) contributed data, and included adolescents living with HIV (ALHIV) enrolled from January 2003 and aged 10 to 19 years (period of adolescence) while under care up to database closure (June 2016). Follow‐up started at age 10 years or the first clinic visit, whichever was later. Entering care at <15 years was a proxy for perinatal infection, while entering care ≥15 years represented infection acquired during adolescence. Competing risk regression was used to assess associations with death and LTFU among those ever receiving triple‐drug antiretroviral therapy (triple‐ART). Results Of the 61,242 ALHIV from 270 clinics in 34 countries included in the analysis, 69% (n = 42,138) entered care <15 years of age (53% female), and 31% (n = 19,104) entered care ≥15 years (81% female). During adolescence, 3.9% died, 30% were LTFU and 8.1% were transferred. For those with infection acquired perinatally versus during adolescence, the four‐year cumulative incidences of mortality were 3.9% versus 5.4% and of LTFU were 26% versus 69% respectively (both p < 0.001). Overall, there were higher hazards of death for females (adjusted sub‐hazard ratio (asHR) 1.19, 95% confidence interval (CI) 1.07 to 1.33), and those starting treatment at ≥5 years of age (highest asHR for age ≥15: 8.72, 95% CI 5.85 to 13.02), and in care in mostly urban (asHR 1.40, 95% CI 1.13 to 1.75) and mostly rural settings (asHR 1.39, 95% CI 1.03 to 1.87) compared to urban settings. Overall, higher hazards of LTFU were observed among females (asHR 1.12, 95% CI 1.07 to 1.17), and those starting treatment at age ≥5 years (highest asHR for age ≥15: 11.11, 95% CI 9.86 to 12.53), in care at district hospitals (asHR 1.27, 95% CI 1.18 to 1.37) or in rural settings (asHR 1.21, 95% CI 1.13 to 1.29), and starting triple‐ART after 2006 (highest asHR for 2011 to 2016 1.84, 95% CI 1.71 to 1.99). Conclusions Both mortality and LTFU were worse among those entering care at ≥15 years. ALHIV should be evaluated apart from younger children and adults to identify population‐specific reasons for death and LTFU.

Attrition is regarded as one of the biggest barriers to effective delivery of antiretroviral therapy (ART) to HIV patients in high-burden settings in sub-Saharan Africa (SSA). In this study, our aim was to assess attrition rates and associated risk factors in patients from a predominantly rural community in the Red Sea region of Eritrea. This was a retrospective study that involved a review of records of HIV patients enrolled for treatment in two referral hospitals in the northern coastal areas of Eritrea between 2005 and 2021. The main outcome measures were attrition (loss-to-follow-up (LTFU) plus mortality) and associated outcomes. The association between outcomes measures and covariates was evaluated investigated using Kaplan-Meir analysis and multivariate Cox regression models. A total of 418 patients were studied. At ART initiation, 269 (64.4%) were females, mean age (±SD) was 34(±11.2) years, median (±IQR) CD4+ T-cell count was 151 (IQR: 87–257) cells/µL, and 230(55%) had stage III/IV disease. Over 39 883 person-months of follow-up (PMFU), retention and attrition comprised 291(69.6%) and 127 (39.4%) of the cases, respectively. Among attrition cases, 97(74. 91%) of the respondents died and 32(25.19%) were LTFU. Overall, the incidence of attrition was 2.9/1000(2.4–3.5) per 1000 PMs. The cumulative risk of attrition at ≤6-, > 6–12-, >12–24-, >24–36-, and at >36–48- and > 48 months were 32(25.2%), 12(9.4%), 17(13.4%), 6(8.7%), 11(8.7%) and 49(38.6%), respectively. In the adjusted multivariate Cox regression model, increased risk of attrition was associated with year of enrollment (aHR = 1.07, 95% CI 1.00–1.15, p-value = 0.04); ethnicity (Afar: aHR=3.21, 95% CI: 1.84–5.59, P< 0.001) (Others: aHR = 2.67, 95% CI: 1.14–6.25, P=0.024) and ART backbone: (TDF+FTC: aHR=2, 95% CI: 1.21–3.32, P=0.007). Further, the risk of attrition decreased per unit increase in baseline CD4+ T-cells/μL (uHR=0.998, 95% CI 0.996–0.999, P<0.001). Attrition in ART centers in the Northern Red Sea regions of Eritrea is largely due to mortality. The high mortality was due to advanced disease at enrollment. A concerted effort is required to reduce late enrollment and improve the management of patients with advanced disease in decentralized programs.

Introduction We previously published a systematic review evaluating retention in care after antiretroviral therapy initiation among adults in low‐ and middle‐income countries from 2008 to 2013. This review evaluates retention after the implementation of Universal Test and Treat (UTT) in 2015. Methods We searched PubMed, ISI Web of Science, Cochrane Database of Systematic Reviews and EMBASE for studies published 1 January 2017, through 31 December 2024 and searched conference repositories from AIDS, IAS and CROI from 2015 to 2024. Retention for each study was estimated using (1) simple averages and (2) interpolated for missing time points through the last reported time point. Our outcomes were all‐cause attrition and retention. We estimated retention rates using a generalized linear mixed model (GLMM) with a logit distribution using interpolated data. Results Seventy studies met our inclusion criteria. Most studies came from Africa, with very few from Europe and Asia. Few studies reported retention past the first 12 months following treatment initiation. Across all studies, we estimated simple average retention without interpolation of missing time points to be 72.6% at 12 months, 75.2% at 24 months, 67.7% at 36 months and 64.8% at 48 months. Utilizing a GLMM model, we estimated retention to be 79.6% at 12 months, 81.2% at 24 months, 75.6% at 36 months and 72.8% at 48 months. Whereas in our prior 2015 review, we estimated retention rates to be 86.0% at 12 months, 79.0% at 24 months, 75.0% at 36 months, and 69.0% at 48 months. These results generally reflect retention at the initiating facility and omit the effect of unreported transfers. Discussion Retention in care at 36 months was estimated to be between 67% and 75%. Compared to results from our prior review, retention is largely similar in the post‐UTT era. Further research evaluating retention in other geographic areas (i.e. Latin America and the Caribbean, Europe, and Asia) is needed. Conclusions Attrition after the first 2 years in treatment remains a concern, and concerted efforts should be made to ensure patients remain engaged in care over their lifetime. The impact of PEPFAR's recent cuts needs to be evaluated further to understand the effect it may have on long‐term retention.