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 : 000033 ( Pmc/Corpus ); précédent : 000032; suivant : 000034Pregnant 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 ; Deidra D. Parrish ; Carolyn M. Audet ; Naomi Chan ; Chisom Odoh ; Usman I. Gebi ; Mukhtar Y. Muhammad ; Bryan E. Shepherd ; C. William Wester ; Sten H. VermundSource :
- 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
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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><nlm:aff id="af7"><addr-line>Westat, Rockville, MD, USA</addr-line></nlm:aff></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. 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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><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></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26012740</idno><idno type="pmc">4654753</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4654753</idno><idno type="RBID">PMC:4654753</idno><idno type="doi">10.1093/inthealth/ihv032</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000033</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000033</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">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</title><author><name sortKey="Aliyu, Muktar H" sort="Aliyu, Muktar H" uniqKey="Aliyu M" first="Muktar H." last="Aliyu">Muktar H. 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><nlm:aff id="af7"><addr-line>Westat, Rockville, MD, USA</addr-line></nlm:aff></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><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></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><nlm:aff id="af9"><addr-line>Friends for Global Health Initiative, Abuja, Nigeria</addr-line></nlm:aff></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><nlm:aff id="af9"><addr-line>Friends for Global Health Initiative, Abuja, Nigeria</addr-line></nlm:aff></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><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></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><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Int Health</journal-id><journal-id journal-id-type="iso-abbrev">Int Health</journal-id><journal-id journal-id-type="publisher-id">inthealth</journal-id><journal-id journal-id-type="hwp">inthealth</journal-id><journal-title-group><journal-title>International Health</journal-title></journal-title-group><issn pub-type="ppub">1876-3413</issn><issn pub-type="epub">1876-3405</issn><publisher><publisher-name>Oxford University Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26012740</article-id><article-id pub-id-type="pmc">4654753</article-id><article-id pub-id-type="doi">10.1093/inthealth/ihv032</article-id><article-id pub-id-type="publisher-id">ihv032</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Articles</subject></subj-group></article-categories><title-group><article-title>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</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Aliyu</surname><given-names>Muktar H.</given-names></name><xref ref-type="aff" rid="af1">a</xref><xref ref-type="aff" rid="af2">b</xref><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>Blevins</surname><given-names>Meridith</given-names></name><xref ref-type="aff" rid="af1">a</xref><xref ref-type="aff" rid="af3">c</xref></contrib><contrib contrib-type="author"><name><surname>Megazzini</surname><given-names>Karen M.</given-names></name><xref ref-type="aff" rid="af7">g</xref></contrib><contrib contrib-type="author"><name><surname>Parrish</surname><given-names>Deidra D.</given-names></name><xref ref-type="aff" rid="af1">a</xref><xref ref-type="aff" rid="af2">b</xref></contrib><contrib contrib-type="author"><name><surname>Audet</surname><given-names>Carolyn M.</given-names></name><xref ref-type="aff" rid="af1">a</xref><xref ref-type="aff" rid="af2">b</xref></contrib><contrib contrib-type="author"><name><surname>Chan</surname><given-names>Naomi</given-names></name><xref ref-type="aff" rid="af1">a</xref><xref ref-type="aff" rid="af4">d</xref></contrib><contrib contrib-type="author"><name><surname>Odoh</surname><given-names>Chisom</given-names></name><xref ref-type="aff" rid="af8">h</xref></contrib><contrib contrib-type="author"><name><surname>Gebi</surname><given-names>Usman I.</given-names></name><xref ref-type="aff" rid="af9">i</xref></contrib><contrib contrib-type="author"><name><surname>Muhammad</surname><given-names>Mukhtar Y.</given-names></name><xref ref-type="aff" rid="af9">i</xref></contrib><contrib contrib-type="author"><name><surname>Shepherd</surname><given-names>Bryan E.</given-names></name><xref ref-type="aff" rid="af1">a</xref><xref ref-type="aff" rid="af3">c</xref></contrib><contrib contrib-type="author"><name><surname>Wester</surname><given-names>C. William</given-names></name><xref ref-type="aff" rid="af1">a</xref><xref ref-type="aff" rid="af5">e</xref></contrib><contrib contrib-type="author"><name><surname>Vermund</surname><given-names>Sten H.</given-names></name><xref ref-type="aff" rid="af1">a</xref><xref ref-type="aff" rid="af6">f</xref></contrib><aff id="af1"><label>a</label><addr-line>Vanderbilt Institute for Global Health</addr-line></aff><aff id="af2"><label>b</label>Departments of Health Policy</aff><aff id="af3"><label>c</label><addr-line>Department of Biostatistics</addr-line></aff><aff id="af4"><label>d</label><addr-line>Department of Human and Organizational Development</addr-line></aff><aff id="af5"><label>e</label><addr-line>Department of Medicine</addr-line></aff><aff id="af6"><label>f</label><addr-line>Department of Pediatrics, Vanderbilt University, 2525 West End Avenue, Suite 750, Nashville, TN 37203, USA</addr-line></aff><aff id="af7"><label>g</label><addr-line>Westat, Rockville, MD, USA</addr-line></aff><aff id="af8"><label>h</label><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></aff><aff id="af9"><label>i</label><addr-line>Friends for Global Health Initiative, Abuja, Nigeria</addr-line></aff></contrib-group><author-notes><corresp id="cor1"><label>*</label>Corresponding author: Tel: + 1 615-343-0626; E-mail: <email>muktar.aliyu@vanderbilt.edu</email></corresp></author-notes><pub-date pub-type="ppub"><month>11</month><year>2015</year></pub-date><pub-date pub-type="epub"><day>25</day><month>5</month><year>2015</year></pub-date><volume>7</volume><issue>6</issue><fpage>405</fpage><lpage>411</lpage><history><date date-type="received"><day>6</day><month>1</month><year>2015</year></date><date date-type="rev-recd"><day>31</day><month>3</month><year>2015</year></date><date date-type="accepted"><day>1</day><month>4</month><year>2015</year></date></history><permissions><copyright-statement>© The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: <email>journals.permissions@oup.com</email>.</copyright-statement><copyright-year>2015</copyright-year></permissions><self-uri content-type="pdf" xlink:type="simple" xlink:href="ihv032.pdf"></self-uri><abstract><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></abstract><kwd-group><kwd>Antiretroviral therapy</kwd><kwd>HIV/AIDS</kwd><kwd>Loss to follow-up</kwd><kwd>Nigeria</kwd><kwd>Retention in care</kwd></kwd-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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