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- Factors Associated With Long-term Retention in Antiretroviral Therapy Among People Living With HIV: Evidence From a Tertiary Hospital in Jakarta, Indonesia
- Ifael Yerosias Mauleti, Krishna Adi Wibisana, Djati Prasetio Syamsuridzal, Sri Mulyati, Vivi Lisdawati, Ika Saptarini, Nurhayati , Armedy Ronny Hasugian, Harimat Hendarwan
- J Prev Med Public Health. 2024;57(3):252-259. Published online April 30, 2024
- DOI: https://doi.org/10.3961/jpmph.23.512
- 809 View
- 126 Download
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Abstract
Summary
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Supplementary Material - Objectives
This study investigated factors associated with the retention of people living with human immunodeficiency virus (HIV) on antiretroviral therapy (ART) during the first 3 years of treatment.
Methods
A retrospective study using electronic health records was conducted at a tertiary hospital in Jakarta, Indonesia. Adult HIV-positive patients who started ART from 2010 until 2020 were included. A binary logistic regression model was used to identify factors associated with ART retention in the first 3 years.
Results
In total, 535 respondents were included in the analysis. The ART retention rates for the first, second, and third years were 83.7%, 79.1%, and 77.2%, respectively. The multivariate analysis revealed a negative association between CD4 count when starting ART and retention. Patients with CD4 counts >200 cells/mL were 0.65 times less likely to have good retention than those with CD4 counts ≤200 cells/mL. The year of starting ART was also significantly associated with retention. Patients who started ART in 2010-2013 or 2014-2016 were less likely to have good retention than those who started ART in 2017-2020, with adjusted odds ratios of 0.52 and 0.40, respectively. Patients who received efavirenz-based therapy were 1.69 times more likely to have good retention than those who received nevirapine (95% confidence interval, 1.05 to 2.72).
Conclusions
Our study revealed a decline in ART retention in the third year. The CD4 count, year of enrollment, and an efavirenz-based regimen were significantly associated with retention. Patient engagement has long been a priority in HIV programs, with interventions being implemented to address this issue. -
SummaryKey Message
The administration of antiretroviral therapy to HIV patients has resulted in increased rates of survival, enhanced quality of life, and less transmission of the virus. Nevertheless, a negative correlation exists between the length of antiretroviral therapy and patient retention in care. Our study used data from a tertiary hospital and indicated a decrease in the retention rate of antiretroviral therapy over the third year. Retention was associated with the CD4 count, year of enrollment, and the use of an efavirenz-based treatment. Emphasizing patient engagement has been a longstanding focus in HIV programs, with initiatives being implemented to tackle this matter.- Effects of Antiretroviral Therapy on the Survival of Human Immunodeficiency Virus-positive Adult Patients in Andhra Pradesh, India: A Retrospective Cohort Study, 2007-2013
- Ram Bajpai, Himanshu Chaturvedi, Lakshmanan Jayaseelan, Pauline Harvey, Nicole Seguy, Laxmikant Chavan, Pinnamaneni Raj, Arvind Pandey
- J Prev Med Public Health. 2016;49(6):394-405. Published online October 28, 2016
- DOI: https://doi.org/10.3961/jpmph.16.073
- 7,461 View
- 167 Download
- 8 Crossref
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Abstract
PDF
- Objectives
The survival outcomes of antiretroviral treatment (ART) programs have not been systematically evaluated at the state level in India. This retrospective study assessed the survival rates and factors associated with survival among adult human immunodeficiency virus (HIV)-infected patients in Andhra Pradesh, India.
Methods
The present study used data from 139 679 HIV patients aged ≥15 years on ART who were registered from 2007 to 2011 and were followed up through December 2013. The primary end point was death of the patient. Mortality densities (per 1000 person-years) were calculated. Kaplan-Meier and Cox-regression models were used to estimate survival and explore the factors associated with survival.
Results
The overall median follow-up time was 16.0 months (2.0 months for the deceased and 14.0 months for those lost to follow-up). Approximately 13.2% of those newly initiated on ART died during follow-up. Of those deaths, 56% occurred in the first three months. The crude mortality rate was 80.9 per 1000 person-years at risk. The CD4 count (adjusted hazard ratio [aHR],4.88; 95% confidence interval [CI], 4.36 to 5.46 for <100 cells/mm3 vs. >350 cells/mm3), functional status (aHR, 3.05; 95% CI, 2.82 to 3.30 for bedridden vs. normal), and body weight (aHR, 3.69; 95% CI, 3.42 to 3.97 for <45 kg vs. >60 kg) were strongly associated with the survival of HIV patients.
Conclusions
The study findings revealed that high mortality was observed within the first three months of ART initiation. Patients with poor baseline clinical characteristics had a higher risk of mortality. Expanded testing and counseling should be encouraged, with the goal of ensuring early enrollment into the program followed by the initiation of ART in HIV-infected patients. -
Summary
Citations
Citations to this article as recorded by
- Association Between Body Mass Index Variation and Early Mortality Among 834 Ethiopian Adults Living with HIV on ART: A Joint Modelling Approach
Animut Alebel, David Sibbritt, Pammla Petrucka, Daniel Demant
Infectious Diseases and Therapy.2023; 12(1): 227. CrossRef - Prognoses of the HIV Infection Under Long-Time Arv Therapy: The Role of Timely Treatment Initiation and the Drugs' Effectiveness
Ramón E. R. González, Pedro Hugo de Figueirêdo, Sergio Galvao Coutinho
SSRN Electronic Journal .2022;[Epub] CrossRef - Rate and Predictors of Mortality Among Adults on Antiretroviral Therapy at Debre Markos Referral Hospital, North West Ethiopia
Haddis Birhanu, Atsede Alle, Molla Yigzaw Birhanu
HIV/AIDS - Research and Palliative Care.2021; Volume 13: 251. CrossRef - Predictors of Mortality Among Adult HIV-Infected Patients Taking Antiretroviral Therapy (ART) in Harari Hospitals, Ethiopia
Abdi Birhanu, Tariku Dingeta, Moti Tolera
HIV/AIDS - Research and Palliative Care.2021; Volume 13: 727. CrossRef - Cost-effectiveness of a novel strategy of HIV/AIDS care in Armed Forces: A stochastic model with Monte Carlo simulation
S. Shankar, Santosh Karade, Rajul K. Gupta, M.V. Singh
Medical Journal Armed Forces India.2020; 76(3): 284. CrossRef - How varying CD4 criteria for treatment initiation was associated with mortality of HIV-patients? A retrospective analysis of electronic health records from Andhra Pradesh, India
Ram Bajpai, Himanshu K Chaturvedi, Josip Car
Journal of Global Health.2020;[Epub] CrossRef - Survival after Long-Term ART Exposure: Findings from an Asian Patient Population Retained in Care beyond 5 Years on ART
Rimke Bijker, Sasisopin Kiertiburanakul, Nagalingeswaran Kumarasamy, Sanjay Pujari, Ly P Sun, Oon T Ng, Man P Lee, Jun Y Choi, Kinh V Nguyen, Yu J Chan, Tuti P Merati, Do D Cuong, Jeremy Ross, Awachana Jiamsakul
Antiviral Therapy.2020; 25(3): 131. CrossRef - Survival rate and mortality risk factors among TB–HIV co-infected patients at an HIV-specialist hospital in Myanmar: A 12-year retrospective follow-up study
Zaw Zaw Aung, Yu Mon Saw, Thu Nandar Saw, Nwe Oo, Hnin Nwe Ni Aye, Sithu Aung, Htun Nyunt Oo, Su Myat Cho, Moe Khaing, Tetsuyoshi Kariya, Eiko Yamamoto, Nobuyuki Hamajima
International Journal of Infectious Diseases.2019; 80: 10. CrossRef
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