Pregnant women with HIV in rural Nigeria have higher rates of antiretroviral treatment initiation, but similar loss to follow-up as non-pregnant women and men
Identifieur interne : 001474 ( Main/Exploration ); précédent : 001473; suivant : 001475Pregnant women with HIV in rural Nigeria have higher rates of antiretroviral treatment initiation, but similar loss to follow-up as non-pregnant women and men
Auteurs : Muktar H. Aliyu ; Meridith Blevins ; Karen M. Megazzini [États-Unis] ; Deidra D. Parrish ; Carolyn M. Audet ; Naomi Chan ; Chisom Odoh [États-Unis] ; Usman I. Gebi [Nigeria] ; Mukhtar Y. Muhammad [Nigeria] ; Bryan E. Shepherd ; C. William Wester ; Sten H. Vermund [États-Unis]Source :
- International Health [ 1876-3413 ] ; 2015.
Abstract
We examined antiretroviral therapy (ART) initiation and retention by sex and pregnancy status in rural Nigeria.
We studied HIV-infected ART-naïve patients aged ≥15 years entering care from June 2009 to September 2013. We calculated the probability of early ART initiation and cumulative incidence of loss to follow-up (LTFU) during the first year of ART, and examined the association between LTFU and sex/pregnancy using Cox regression.
The cohort included 3813 ART-naïve HIV-infected adults (2594 women [68.0%], 273 [11.8%] of them pregnant). The proportion of pregnant clients initiating ART within 90 days of enrollment (78.0%, 213/273) was higher than among non-pregnant women (54.3%,1261/2321) or men (53.0%, 650/1219), both p<0.001. Pregnant women initiated ART sooner than non-pregnant women and men (median [IQR] days from enrollment to ART initiation for pregnant women=7 days [0–21] vs 14 days [7–49] for non-pregnant women and 14 days [7–42] for men; p<0.001). Cumulative incidence of LTFU during the first year post-ART initiation was high and did not differ by sex and pregnancy status. Persons who were unemployed, bedridden, had higher CD4+ counts, and/or in earlier WHO clinical stages were more likely to be LTFU.
Pregnant women with HIV in rural Nigeria were more likely to initiate ART but were no more likely to be retained in care. Our findings underscore the importance of effective retention strategies across all patient groups, regardless of sex and pregnancy status.
Url:
DOI: 10.1093/inthealth/ihv032
PubMed: 26012740
PubMed Central: 4654753
Affiliations:
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Aliyu</name><affiliation><nlm:aff id="af1"><addr-line>Vanderbilt Institute for Global Health</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="af2">Departments of Health Policy</nlm:aff></affiliation></author><author><name sortKey="Blevins, Meridith" sort="Blevins, Meridith" uniqKey="Blevins M" first="Meridith" last="Blevins">Meridith Blevins</name><affiliation><nlm:aff id="af1"><addr-line>Vanderbilt Institute for Global Health</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="af3"><addr-line>Department of Biostatistics</addr-line></nlm:aff></affiliation></author><author><name sortKey="Megazzini, Karen M" sort="Megazzini, Karen M" uniqKey="Megazzini K" first="Karen M." last="Megazzini">Karen M. Megazzini</name><affiliation wicri:level="2"><nlm:aff id="af7"><addr-line>Westat, Rockville, MD, USA</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Westat, Rockville, MD</wicri:regionArea><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Parrish, Deidra D" sort="Parrish, Deidra D" uniqKey="Parrish D" first="Deidra D." last="Parrish">Deidra D. Parrish</name><affiliation><nlm:aff id="af1"><addr-line>Vanderbilt Institute for Global Health</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="af2">Departments of Health Policy</nlm:aff></affiliation></author><author><name sortKey="Audet, Carolyn M" sort="Audet, Carolyn M" uniqKey="Audet C" first="Carolyn M." last="Audet">Carolyn M. Audet</name><affiliation><nlm:aff id="af1"><addr-line>Vanderbilt Institute for Global Health</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="af2">Departments of Health Policy</nlm:aff></affiliation></author><author><name sortKey="Chan, Naomi" sort="Chan, Naomi" uniqKey="Chan N" first="Naomi" last="Chan">Naomi Chan</name><affiliation><nlm:aff id="af1"><addr-line>Vanderbilt Institute for Global Health</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="af4"><addr-line>Department of Human and Organizational Development</addr-line></nlm:aff></affiliation></author><author><name sortKey="Odoh, Chisom" sort="Odoh, Chisom" uniqKey="Odoh C" first="Chisom" last="Odoh">Chisom Odoh</name><affiliation wicri:level="2"><nlm:aff id="af8"><addr-line>Department of Health Administration and Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-400, Nashville, TN 37203, USA</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Health Administration and Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-400, Nashville, TN 37203</wicri:regionArea><placeName><region type="state">Tennessee</region></placeName></affiliation></author><author><name sortKey="Gebi, Usman I" sort="Gebi, Usman I" uniqKey="Gebi U" first="Usman I." last="Gebi">Usman I. Gebi</name><affiliation wicri:level="1"><nlm:aff id="af9"><addr-line>Friends for Global Health Initiative, Abuja, Nigeria</addr-line></nlm:aff><country xml:lang="fr">Nigeria</country><wicri:regionArea>Friends for Global Health Initiative, Abuja</wicri:regionArea><wicri:noRegion>Abuja</wicri:noRegion></affiliation></author><author><name sortKey="Muhammad, Mukhtar Y" sort="Muhammad, Mukhtar Y" uniqKey="Muhammad M" first="Mukhtar Y." last="Muhammad">Mukhtar Y. Muhammad</name><affiliation wicri:level="1"><nlm:aff id="af9"><addr-line>Friends for Global Health Initiative, Abuja, Nigeria</addr-line></nlm:aff><country xml:lang="fr">Nigeria</country><wicri:regionArea>Friends for Global Health Initiative, Abuja</wicri:regionArea><wicri:noRegion>Abuja</wicri:noRegion></affiliation></author><author><name sortKey="Shepherd, Bryan E" sort="Shepherd, Bryan E" uniqKey="Shepherd B" first="Bryan E." last="Shepherd">Bryan E. Shepherd</name><affiliation><nlm:aff id="af1"><addr-line>Vanderbilt Institute for Global Health</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="af3"><addr-line>Department of Biostatistics</addr-line></nlm:aff></affiliation></author><author><name sortKey="Wester, C William" sort="Wester, C William" uniqKey="Wester C" first="C. William" last="Wester">C. William Wester</name><affiliation><nlm:aff id="af1"><addr-line>Vanderbilt Institute for Global Health</addr-line></nlm:aff></affiliation><affiliation><nlm:aff id="af5"><addr-line>Department of Medicine</addr-line></nlm:aff></affiliation></author><author><name sortKey="Vermund, Sten H" sort="Vermund, Sten H" uniqKey="Vermund S" first="Sten H." last="Vermund">Sten H. Vermund</name><affiliation><nlm:aff id="af1"><addr-line>Vanderbilt Institute for Global Health</addr-line></nlm:aff></affiliation><affiliation wicri:level="2"><nlm:aff id="af6"><addr-line>Department of Pediatrics, Vanderbilt University, 2525 West End Avenue, Suite 750, Nashville, TN 37203, USA</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Pediatrics, Vanderbilt University, 2525 West End Avenue, Suite 750, Nashville, TN 37203</wicri:regionArea><placeName><region type="state">Tennessee</region></placeName></affiliation></author></analytic><series><title level="j">International Health</title><idno type="ISSN">1876-3413</idno><idno type="eISSN">1876-3405</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>We examined antiretroviral therapy (ART) initiation and retention by sex and pregnancy status in rural Nigeria.</p></sec><sec><title>Methods</title><p>We studied HIV-infected ART-naïve patients aged ≥15 years entering care from June 2009 to September 2013. We calculated the probability of early ART initiation and cumulative incidence of loss to follow-up (LTFU) during the first year of ART, and examined the association between LTFU and sex/pregnancy using Cox regression.</p></sec><sec><title>Results</title><p>The cohort included 3813 ART-naïve HIV-infected adults (2594 women [68.0%], 273 [11.8%] of them pregnant). The proportion of pregnant clients initiating ART within 90 days of enrollment (78.0%, 213/273) was higher than among non-pregnant women (54.3%,1261/2321) or men (53.0%, 650/1219), both p<0.001. Pregnant women initiated ART sooner than non-pregnant women and men (median [IQR] days from enrollment to ART initiation for pregnant women=7 days [0–21] vs 14 days [7–49] for non-pregnant women and 14 days [7–42] for men; p<0.001). Cumulative incidence of LTFU during the first year post-ART initiation was high and did not differ by sex and pregnancy status. Persons who were unemployed, bedridden, had higher CD4+ counts, and/or in earlier WHO clinical stages were more likely to be LTFU.</p></sec><sec><title>Conclusions</title><p>Pregnant women with HIV in rural Nigeria were more likely to initiate ART but were no more likely to be retained in care. Our findings underscore the importance of effective retention strategies across all patient groups, regardless of sex and pregnancy status.</p></sec></div></front></TEI><affiliations><list><country><li>Nigeria</li><li>États-Unis</li></country><region><li>Maryland</li><li>Tennessee</li></region></list><tree><noCountry><name sortKey="Aliyu, Muktar H" sort="Aliyu, Muktar H" uniqKey="Aliyu M" first="Muktar H." last="Aliyu">Muktar H. Aliyu</name><name sortKey="Audet, Carolyn M" sort="Audet, Carolyn M" uniqKey="Audet C" first="Carolyn M." last="Audet">Carolyn M. Audet</name><name sortKey="Blevins, Meridith" sort="Blevins, Meridith" uniqKey="Blevins M" first="Meridith" last="Blevins">Meridith Blevins</name><name sortKey="Chan, Naomi" sort="Chan, Naomi" uniqKey="Chan N" first="Naomi" last="Chan">Naomi Chan</name><name sortKey="Parrish, Deidra D" sort="Parrish, Deidra D" uniqKey="Parrish D" first="Deidra D." last="Parrish">Deidra D. Parrish</name><name sortKey="Shepherd, Bryan E" sort="Shepherd, Bryan E" uniqKey="Shepherd B" first="Bryan E." last="Shepherd">Bryan E. Shepherd</name><name sortKey="Wester, C William" sort="Wester, C William" uniqKey="Wester C" first="C. William" last="Wester">C. William Wester</name></noCountry><country name="États-Unis"><region name="Maryland"><name sortKey="Megazzini, Karen M" sort="Megazzini, Karen M" uniqKey="Megazzini K" first="Karen M." last="Megazzini">Karen M. Megazzini</name></region><name sortKey="Odoh, Chisom" sort="Odoh, Chisom" uniqKey="Odoh C" first="Chisom" last="Odoh">Chisom Odoh</name><name sortKey="Vermund, Sten H" sort="Vermund, Sten H" uniqKey="Vermund S" first="Sten H." last="Vermund">Sten H. Vermund</name></country><country name="Nigeria"><noRegion><name sortKey="Gebi, Usman I" sort="Gebi, Usman I" uniqKey="Gebi U" first="Usman I." last="Gebi">Usman I. Gebi</name></noRegion><name sortKey="Muhammad, Mukhtar Y" sort="Muhammad, Mukhtar Y" uniqKey="Muhammad M" first="Mukhtar Y." last="Muhammad">Mukhtar Y. Muhammad</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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