Return to Normal Life After AIDS as a Reason for Lost to Follow-up in a Community-Based Antiretroviral Treatment Program
Identifieur interne : 001905 ( Pmc/Corpus ); précédent : 001904; suivant : 001906Return to Normal Life After AIDS as a Reason for Lost to Follow-up in a Community-Based Antiretroviral Treatment Program
Auteurs : Stella T. Alamo ; Robert Colebunders ; Joseph Ouma ; Pamela Sunday ; Glenn Wagner ; Fred Wabwire-Mangen ; Marie LagaSource :
- Journal of acquired immune deficiency syndromes (1999) [ 1525-4135 ] ; 2012.
Abstract
To understand reasons for lost-to-follow-up (LTFU) from a community-based antiretroviral therapy program in Uganda.
Retrospective cohort of patients LTFU between May 31, 2001, to May 31, 2010, was examined. A representative sample of 579 patients traced to ascertain their outcomes.
Mixed methods were used. Using “stopped care” as the hazard and “self-transferred” as the comparator, we examined using Cox proportional multivariable model risk factors for stopping care.
Overall, 2933 of 3954 (74.0%) patients were LTFU. Of 579 of 2933 (19%) patients sampled for tracing, 32 (5.5%) were untraceable, 66(11.4 %) were dead, and 481 (83.0%) found alive. Of those found alive, 232 (40.0%) stopped care, 249 (43.0%) self-transferred, whereas 61 (12.7%) returned to care at Reach Out Mbuya HIV/AIDS Initiative. In adjusted hazards ratios, born-again religion, originating from outside Kampala, resident in Kampala for <5 years but >1 year, having school-age children who were out of school, non-HIV disclosure, CD4 counts >250 cells per cubic millimeter and pre–antiretroviral therapy were associated with increased risk of stopping care. Qualitative interviews revealed return to a normal life as a key reason for LTFU.Of 61 patients who returned to care, their median CD4 count at LTFU was higher than on return into care (401/mm3 vs. 205/mm3,
Many patients become LTFU during the course of years, necessitating the need for effective mechanisms to identify those in need of close monitoring. Efforts should be made to improve referrals and mechanisms to track patients who transfer to different facilities. Additionally, tracing of patients who become LTFU is required to convince them to return.
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DOI: 10.1097/FTD.0b013e3182526e6a
PubMed: 22622076
PubMed Central: 3872063
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Alamo</name><affiliation><nlm:aff id="A1">Medical Department, Reach Out Mbuya Parish HIV/AIDS Initiative, Kampala, Uganda</nlm:aff></affiliation></author><author><name sortKey="Colebunders, Robert" sort="Colebunders, Robert" uniqKey="Colebunders R" first="Robert" last="Colebunders">Robert Colebunders</name><affiliation><nlm:aff id="A2">Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium</nlm:aff></affiliation><affiliation><nlm:aff id="A3">Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium</nlm:aff></affiliation></author><author><name sortKey="Ouma, Joseph" sort="Ouma, Joseph" uniqKey="Ouma J" first="Joseph" last="Ouma">Joseph Ouma</name><affiliation><nlm:aff id="A4">Department of Strategic Planning, Management Sciences for Health, Kampala, Uganda</nlm:aff></affiliation></author><author><name sortKey="Sunday, Pamela" sort="Sunday, Pamela" uniqKey="Sunday P" first="Pamela" last="Sunday">Pamela Sunday</name><affiliation><nlm:aff id="A5">Monitoring and Evaluation Department, Reach Out Mbuya Parish HIV/AIDS Initiative, Kampala, Uganda</nlm:aff></affiliation></author><author><name sortKey="Wagner, Glenn" sort="Wagner, Glenn" uniqKey="Wagner G" first="Glenn" last="Wagner">Glenn Wagner</name><affiliation><nlm:aff id="A6">Health Unit, RAND Cooperation, Santa Monica, CA</nlm:aff></affiliation></author><author><name sortKey="Wabwire Mangen, Fred" sort="Wabwire Mangen, Fred" uniqKey="Wabwire Mangen F" first="Fred" last="Wabwire-Mangen">Fred Wabwire-Mangen</name><affiliation><nlm:aff id="A7">Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda</nlm:aff></affiliation></author><author><name sortKey="Laga, Marie" sort="Laga, Marie" uniqKey="Laga M" first="Marie" last="Laga">Marie Laga</name><affiliation><nlm:aff id="A8">HIV Epidemiology and Control Unit, Institute of Tropical Medicine, Antwerp.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22622076</idno><idno type="pmc">3872063</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872063</idno><idno type="RBID">PMC:3872063</idno><idno type="doi">10.1097/FTD.0b013e3182526e6a</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">001905</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001905</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Return to Normal Life After AIDS as a Reason for Lost to Follow-up in a Community-Based Antiretroviral Treatment Program</title><author><name sortKey="Alamo, Stella T" sort="Alamo, Stella T" uniqKey="Alamo S" first="Stella T." last="Alamo">Stella T. Alamo</name><affiliation><nlm:aff id="A1">Medical Department, Reach Out Mbuya Parish HIV/AIDS Initiative, Kampala, Uganda</nlm:aff></affiliation></author><author><name sortKey="Colebunders, Robert" sort="Colebunders, Robert" uniqKey="Colebunders R" first="Robert" last="Colebunders">Robert Colebunders</name><affiliation><nlm:aff id="A2">Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium</nlm:aff></affiliation><affiliation><nlm:aff id="A3">Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium</nlm:aff></affiliation></author><author><name sortKey="Ouma, Joseph" sort="Ouma, Joseph" uniqKey="Ouma J" first="Joseph" last="Ouma">Joseph Ouma</name><affiliation><nlm:aff id="A4">Department of Strategic Planning, Management Sciences for Health, Kampala, Uganda</nlm:aff></affiliation></author><author><name sortKey="Sunday, Pamela" sort="Sunday, Pamela" uniqKey="Sunday P" first="Pamela" last="Sunday">Pamela Sunday</name><affiliation><nlm:aff id="A5">Monitoring and Evaluation Department, Reach Out Mbuya Parish HIV/AIDS Initiative, Kampala, Uganda</nlm:aff></affiliation></author><author><name sortKey="Wagner, Glenn" sort="Wagner, Glenn" uniqKey="Wagner G" first="Glenn" last="Wagner">Glenn Wagner</name><affiliation><nlm:aff id="A6">Health Unit, RAND Cooperation, Santa Monica, CA</nlm:aff></affiliation></author><author><name sortKey="Wabwire Mangen, Fred" sort="Wabwire Mangen, Fred" uniqKey="Wabwire Mangen F" first="Fred" last="Wabwire-Mangen">Fred Wabwire-Mangen</name><affiliation><nlm:aff id="A7">Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda</nlm:aff></affiliation></author><author><name sortKey="Laga, Marie" sort="Laga, Marie" uniqKey="Laga M" first="Marie" last="Laga">Marie Laga</name><affiliation><nlm:aff id="A8">HIV Epidemiology and Control Unit, Institute of Tropical Medicine, Antwerp.</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of acquired immune deficiency syndromes (1999)</title><idno type="ISSN">1525-4135</idno><idno type="eISSN">1944-7884</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objectives</title><p id="P1">To understand reasons for lost-to-follow-up (LTFU) from a community-based antiretroviral therapy program in Uganda.</p></sec><sec id="S2"><title>Study Design</title><p id="P2">Retrospective cohort of patients LTFU between May 31, 2001, to May 31, 2010, was examined. A representative sample of 579 patients traced to ascertain their outcomes.</p></sec><sec id="S3"><title>Methods</title><p id="P3">Mixed methods were used. Using “stopped care” as the hazard and “self-transferred” as the comparator, we examined using Cox proportional multivariable model risk factors for stopping care.</p></sec><sec id="S4"><title>Results</title><p id="P4">Overall, 2933 of 3954 (74.0%) patients were LTFU. Of 579 of 2933 (19%) patients sampled for tracing, 32 (5.5%) were untraceable, 66(11.4 %) were dead, and 481 (83.0%) found alive. Of those found alive, 232 (40.0%) stopped care, 249 (43.0%) self-transferred, whereas 61 (12.7%) returned to care at Reach Out Mbuya HIV/AIDS Initiative. In adjusted hazards ratios, born-again religion, originating from outside Kampala, resident in Kampala for <5 years but >1 year, having school-age children who were out of school, non-HIV disclosure, CD4 counts >250 cells per cubic millimeter and pre–antiretroviral therapy were associated with increased risk of stopping care. Qualitative interviews revealed return to a normal life as a key reason for LTFU.Of 61 patients who returned to care, their median CD4 count at LTFU was higher than on return into care (401/mm<sup>3</sup> vs. 205/mm<sup>3</sup>, <italic>P</italic> < 0.0001).</p></sec><sec id="S5"><title>Conclusions</title><p id="P5">Many patients become LTFU during the course of years, necessitating the need for effective mechanisms to identify those in need of close monitoring. Efforts should be made to improve referrals and mechanisms to track patients who transfer to different facilities. Additionally, tracing of patients who become LTFU is required to convince them to return.</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>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">100892005</journal-id><journal-id journal-id-type="pubmed-jr-id">21821</journal-id><journal-id journal-id-type="nlm-ta">J Acquir Immune Defic Syndr</journal-id><journal-id journal-id-type="iso-abbrev">J. Acquir. Immune Defic. Syndr.</journal-id><journal-title-group><journal-title>Journal of acquired immune deficiency syndromes (1999)</journal-title></journal-title-group><issn pub-type="ppub">1525-4135</issn><issn pub-type="epub">1944-7884</issn></journal-meta><article-meta><article-id pub-id-type="pmid">22622076</article-id><article-id pub-id-type="pmc">3872063</article-id><article-id pub-id-type="doi">10.1097/FTD.0b013e3182526e6a</article-id><article-id pub-id-type="manuscript">NIHMS536311</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Return to Normal Life After AIDS as a Reason for Lost to Follow-up in a Community-Based Antiretroviral Treatment Program</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Alamo</surname><given-names>Stella T.</given-names></name><degrees>MD, MDC</degrees><xref ref-type="aff" rid="A1">*</xref></contrib><contrib contrib-type="author"><name><surname>Colebunders</surname><given-names>Robert</given-names></name><degrees>MD, PhD</degrees><xref ref-type="aff" rid="A2">†</xref><xref ref-type="aff" rid="A3">‡</xref></contrib><contrib contrib-type="author"><name><surname>Ouma</surname><given-names>Joseph</given-names></name><degrees>BStat, MStat</degrees><xref ref-type="aff" rid="A4">§</xref></contrib><contrib contrib-type="author"><name><surname>Sunday</surname><given-names>Pamela</given-names></name><degrees>BScQE</degrees><xref ref-type="aff" rid="A5">∥</xref></contrib><contrib contrib-type="author"><name><surname>Wagner</surname><given-names>Glenn</given-names></name><degrees>PhD</degrees><xref ref-type="aff" rid="A6">¶</xref></contrib><contrib contrib-type="author"><name><surname>Wabwire-Mangen</surname><given-names>Fred</given-names></name><degrees>MD, PhD</degrees><xref ref-type="aff" rid="A7">#</xref></contrib><contrib contrib-type="author"><name><surname>Laga</surname><given-names>Marie</given-names></name><degrees>MD, PhD</degrees><xref ref-type="aff" rid="A8">**</xref></contrib></contrib-group><aff id="A1"><label>*</label>Medical Department, Reach Out Mbuya Parish HIV/AIDS Initiative, Kampala, Uganda</aff><aff id="A2"><label>†</label>Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium</aff><aff id="A3"><label>‡</label>Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium</aff><aff id="A4"><label>§</label>Department of Strategic Planning, Management Sciences for Health, Kampala, Uganda</aff><aff id="A5"><label>∥</label>Monitoring and Evaluation Department, Reach Out Mbuya Parish HIV/AIDS Initiative, Kampala, Uganda</aff><aff id="A6"><label>¶</label>Health Unit, RAND Cooperation, Santa Monica, CA</aff><aff id="A7"><label>#</label>Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda</aff><aff id="A8"><label>**</label>HIV Epidemiology and Control Unit, Institute of Tropical Medicine, Antwerp.</aff><author-notes><corresp id="CR1">Correspondence to: Stella T. Alamo, MD, MDC, Reach Out Mbuya HIV/AIDS Initiative, PO Box 7303, Kampala, Uganda (<email>stellaalamo@gmail.com</email>).</corresp></author-notes><pub-date pub-type="nihms-submitted"><day>17</day><month>12</month><year>2013</year></pub-date><pub-date pub-type="ppub"><day>1</day><month>6</month><year>2012</year></pub-date><pub-date pub-type="pmc-release"><day>24</day><month>12</month><year>2013</year></pub-date><volume>60</volume><issue>2</issue><elocation-id>10.1097/FTD.0b013e3182526e6a</elocation-id><permissions><copyright-statement>Copyright © 2012 by Lippincott Williams & Wilkins</copyright-statement><copyright-year>2012</copyright-year></permissions><abstract><sec id="S1"><title>Objectives</title><p id="P1">To understand reasons for lost-to-follow-up (LTFU) from a community-based antiretroviral therapy program in Uganda.</p></sec><sec id="S2"><title>Study Design</title><p id="P2">Retrospective cohort of patients LTFU between May 31, 2001, to May 31, 2010, was examined. A representative sample of 579 patients traced to ascertain their outcomes.</p></sec><sec id="S3"><title>Methods</title><p id="P3">Mixed methods were used. Using “stopped care” as the hazard and “self-transferred” as the comparator, we examined using Cox proportional multivariable model risk factors for stopping care.</p></sec><sec id="S4"><title>Results</title><p id="P4">Overall, 2933 of 3954 (74.0%) patients were LTFU. Of 579 of 2933 (19%) patients sampled for tracing, 32 (5.5%) were untraceable, 66(11.4 %) were dead, and 481 (83.0%) found alive. Of those found alive, 232 (40.0%) stopped care, 249 (43.0%) self-transferred, whereas 61 (12.7%) returned to care at Reach Out Mbuya HIV/AIDS Initiative. In adjusted hazards ratios, born-again religion, originating from outside Kampala, resident in Kampala for <5 years but >1 year, having school-age children who were out of school, non-HIV disclosure, CD4 counts >250 cells per cubic millimeter and pre–antiretroviral therapy were associated with increased risk of stopping care. Qualitative interviews revealed return to a normal life as a key reason for LTFU.Of 61 patients who returned to care, their median CD4 count at LTFU was higher than on return into care (401/mm<sup>3</sup> vs. 205/mm<sup>3</sup>, <italic>P</italic> < 0.0001).</p></sec><sec id="S5"><title>Conclusions</title><p id="P5">Many patients become LTFU during the course of years, necessitating the need for effective mechanisms to identify those in need of close monitoring. Efforts should be made to improve referrals and mechanisms to track patients who transfer to different facilities. Additionally, tracing of patients who become LTFU is required to convince them to return.</p></sec></abstract><kwd-group><kwd>loss to follow up</kwd><kwd>stopped care</kwd><kwd>self-transferred</kwd><kwd>patient tracing</kwd></kwd-group><funding-group><award-group><funding-source country="United States">National Institute of Child Health & Human Development : NICHD</funding-source><award-id>R24 HD056651 || HD</award-id></award-group></funding-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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