| Title |
Trends, treatment outcomes, and determinants for attrition among adult patients in care at a large tertiary HIV clinic in Nairobi, Kenya: a 2004–2015 retrospective cohort study
|
|---|---|
| Published in |
HIV/AIDS (Auckland, N.Z.), June 2018
|
| DOI | 10.2147/hiv.s153185 |
| Pubmed ID | |
| Authors |
Jared O Mecha, Elizabeth N Kubo, Lucy W Nganga, Peter N Muiruri, Lilian N Njagi, Syokau Ilovi, Richard Ngethe, Immaculate Mutisya, Evelyn W Ngugi, Elizabeth Maleche-Obimbo |
| Abstract |
Understanding trends in patient profiles and identifying predictors for adverse outcomes are key to improving the effectiveness of HIV care and treatment programs. Previous work in Kenya has documented findings from a rural setting. This paper describes trends in demographic and clinical characteristics of antiretroviral therapy (ART) treatment cohorts at a large urban, referral HIV clinic and explores treatment outcomes and factors associated with attrition during 12 years of follow-up. This was a retrospective cohort analysis of HIV-infected adults who started ART between January 1, 2004, and September 30, 2015. ART-experienced patients and those with missing data were excluded. The Cochran-Armitage test was used to determine trends in baseline characteristics over time. Cox proportional hazards models were used to determine the effect of baseline characteristics on attrition. ART uptake among older adolescents (15-19 years), youth, and young adults increased over time (p=0.0001). Independent predictors for attrition included (adjusted hazard ratio [95% CI]) male sex: 1.30 (1.16-1.45), p=0.0001; age: 15-19 years: 1.83 (1.26-2.66), p=0.0014; 20-24 years: 1.93 (1.52-2.44), p=0.0001; and 25-29 years: 1.31 (1.11-1.54), p=0.0012; marital status - single: 1.27 (1.11-1.44), p=0.0005; and divorced/separated: 1.56 (1.30-1.87), p=0.0001; urban residence: 1.40 (1.20-1.64), p=0.0001; entry into HIV care following hospitalization: 1.31 (1.10-1.57), p=0.0026, or transfer from another facility: 1.60 (1.26-2.04), p=0.0001; initiation of ART more than 12 months after the date of HIV diagnosis: 1.36 (1.19-1.55), p=0.0001, and history of a current or past opportunistic infection (OI): 1.15 (1.02-1.30), p=0.0284. Although ART uptake among adolescents and young people increased over time, this group was at increased risk for attrition. Single marital status, urban residence, history of hospitalization or OI, and delayed initiation of ART also predicted attrition. This calls for focused evidence-informed strategies to address attrition and improve outcomes. |
X Demographics
The data shown below were collected from the profiles of 2 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 2 | 100% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 2 | 100% |
Mendeley readers
The data shown below were compiled from readership statistics for 81 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 81 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Master | 21 | 26% |
| Researcher | 9 | 11% |
| Student > Ph. D. Student | 8 | 10% |
| Student > Bachelor | 4 | 5% |
| Lecturer | 4 | 5% |
| Other | 13 | 16% |
| Unknown | 22 | 27% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 16 | 20% |
| Nursing and Health Professions | 14 | 17% |
| Social Sciences | 4 | 5% |
| Unspecified | 4 | 5% |
| Agricultural and Biological Sciences | 3 | 4% |
| Other | 18 | 22% |
| Unknown | 22 | 27% |
Attention Score in Context
This research output has an Altmetric Attention Score of 4. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 01 June 2019.
All research outputs
#7,782,070
of 25,385,509 outputs
Outputs from HIV/AIDS (Auckland, N.Z.)
#71
of 330 outputs
Outputs of similar age
#124,764
of 342,877 outputs
Outputs of similar age from HIV/AIDS (Auckland, N.Z.)
#4
of 9 outputs
Altmetric has tracked 25,385,509 research outputs across all sources so far. This one has received more attention than most of these and is in the 69th percentile.
So far Altmetric has tracked 330 research outputs from this source. They receive a mean Attention Score of 3.5. This one has done well, scoring higher than 77% of its peers.
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