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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
The importance of clinic attendance in the first six months on antiretroviral treatment: A retrospective analysis at a large public sector HIV clinic in South Africa
Journal of the International AIDS Society, Volume 13, No. 1, Article 49, Year 2010
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Description
Background. Adherence to care and treatment are essential for HIV-infected individuals to benefit from antiretroviral therapy (ART). We sought to quantify the effects on treatment outcomes of missing visits soon after initiating ART. Methods. We analyzed data from HIV-infected patients initiating ART at Themba Lethu Clinic, Johannesburg, South Africa, from April 2004 to August 2008. We used log-binomial regression to evaluate the relative risk of missing visits during the first six months of ART on immunological response and virologic suppression. Cox models were used to evaluate the relationship between missed visits and mortality and loss to follow up over 12 months. Results. Of 4476 patients, 65% missed no visits, while 26% missed one visit, 7% missed two and 1.6% missed three or more visits during the first six months on treatment. Patients who missed three or more medical or antiretroviral (ARV) visits had a two-fold increased risk of poor CD4 response by six months, while the risk of failing to achieve virologic suppression by six months increased two- to five-fold among patients who missed two and three or more medical or ARV visits. Adjusted Cox models showed that patients who missed two (HR 2.1; 95% CI: 1.0-4.3) and three or more (HR 4.7; 95% CI: 1.4-16.2) medical visits had an increased risk of death, while those who missed two ARV (HR 3.8; 95% CI: 2.5-5.8) or three or more medical (HR 3.0; 95% CI: 1.1-8.1) visits had an increased risk of loss to follow up. Conclusions. Thirty-five percent of patients missed one or more visits in the first six months on treatment, increasing their risk of poorer outcomes. These patients could be targeted for additional adherence counselling to help improve ART outcomes. © 2010 Brennan et al; licensee BioMed Central Ltd.
Authors & Co-Authors
Brennan, Alana T.
United States, Boston
School of Public Health
South Africa, Johannesburg
Health Economics and Epidemiology Research Office
South Africa, Johannesburg
University of the Witwatersrand
Maskew, Mhairi
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Sanne, Ian
South Africa, Johannesburg
Right to Care
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Fox, Matthew P.
United States, Boston
School of Public Health
South Africa, Johannesburg
Health Economics and Epidemiology Research Office
South Africa, Johannesburg
University of the Witwatersrand
United States, Boston
Boston University
Statistics
Citations: 84
Authors: 4
Affiliations: 6
Identifiers
Doi:
10.1186/1758-2652-13-49
e-ISSN:
17582652
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Locations
South Africa