Incidence, Predictors and Reasons of Attrition of Patients on Antiretroviral Therapy for HIV in Eight Large-Cohort Sites in Conakry

Niouma Nestor Leno; Jean Michel Lamah; Foromo Guilavogui; Thierno Saidou Diallo; Youssouf Koita; Laye Kaba; Arnold Ahiatsi; Nagnouman Toure; Souleymane Chaloub; Andre Kamano; Mahamadou Drabo; Jean Gaudart

doi:doi:10.11648/j.ijhpebs.20230901.12

Incidence, Predictors and Reasons of Attrition of Patients on Antiretroviral Therapy for HIV in Eight Large-Cohort Sites in Conakry

Niouma Nestor Leno, Jean Michel Lamah, Foromo Guilavogui, Thierno Saidou Diallo, Youssouf Koita, Laye Kaba, Arnold Ahiatsi, Nagnouman Toure, Souleymane Chaloub, Andre Kamano, Mahamadou Drabo, Jean Gaudart

Published in International Journal of HIV/AIDS Prevention, Education and Behavioural Science (Volume 9, Issue 1)

Received: 20 December 2022 Accepted: 6 January 2023 Published: 17 January 2023

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Abstract

Introduction: The purpose of this study was to estimate the incidence of attrition (death and lost to follow-up) among patients living with HIV on ART and to identify key predictors of this attrition. It also described the reasons why some patients are lost to follow-up. Methods: This was a historical cohort study of patients living with HIV put on ART between January 1, 2015 and December 31, 2020 in 8 large cohort sites in Conakry. An additional cross-sectional survey in the form of an investigation was conducted to describe the final status of patients reported lost to follow-up by the sites, as well as to describe the reasons for their loss to follow-up. Kaplan Meier techniques were used to estimate cumulative incidence, and the multivariate Cox proportional model was used to identify predictors of attrition. Results: The cumulative incidence of attrition was 19.50 over a median follow-up time of 2.5 years, for an overall attrition rate of 7.79 years per 100 person-years. Factors significantly associated with attrition were: Age 15 - 24 years [aHR = 2.212; 95% CI (1.321 - 3.704)], age >35 years [aHR = 1.723; 95% CI (1.041 - 2.852)], viral load >100,000 copies/ml [aHR = 2.056; 95% CI (1.668 - 2.534)], patients not on the 3-month or 6-month appointment system [aHR = 3.031; 95% CI (2.603 - 3.531)]. Conclusion: This study showed that the incidence of attrition increases with increasing follow-up time. Investigation of lost to follow-up reduced the estimated number of patients considered lost to follow-up and increased the number of deaths that were previously underreported. A prospective mixed study including many more variables would allow a better understanding of the attrition phenomenon among people living with HIV on ART in Guinea.

Published in	International Journal of HIV/AIDS Prevention, Education and Behavioural Science (Volume 9, Issue 1)
DOI	10.11648/j.ijhpebs.20230901.12
Page(s)	9-19
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

Attrition, Reasons, Predictors, Antiretroviral Treatment, HIV/AIDS, Conakry

References

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[2]	Dejen D, Jara D, Yeshanew F, Fentaw Z, Mengie Feleke T, Girmaw F, et al. Attrition and Its Predictors Among Adults Receiving First-Line Antiretroviral Therapy in Woldia Town Public Health Facilities, Northeast Ethiopia: A Retrospective Cohort Study. HIVAIDS Auckl NZ. 20 avr 2021; 13: 445-54.
[3]	Kalinjuma AV, Glass TR, Weisser M, Myeya SJ, Kasuga B, Kisung’a Y, et al. Prospective assessment of loss to follow-up: incidence and associated factors in a cohort of HIV-positive adults in rural Tanzania. J Int AIDS Soc. 3 mars 2020; 23 (3): e25460.
[4]	Tweya H, Oboho IK, Gugsa ST, Phiri S, Rambiki E, Banda R, et al. Loss to follow-up before and after initiation of antiretroviral therapy in HIV facilities in Lilongwe, Malawi. PloS One. 2018; 13 (1): e0188488.
[5]	Luebbert J, Tweya H, Phiri S, Chaweza T, Mwafilaso J, Hosseinipour MC, et al. Virological Failure and Drug Resistance in Patients on Antiretroviral Therapy After Treatment Interruption in Lilongwe, Malawi. Clin Infect Dis. 1 août 2012; 55 (3): 441-8.
[6]	Fuente-Soro L, López-Varela E, Augusto O, Bernardo EL, Sacoor C, Nhacolo A, et al. Loss to follow-up and opportunities for reengagement in HIV care in rural Mozambique. Medicine (Baltimore). 15 mai 2020; 99 (20): e20236.
[7]	Alvarez-Uria G, Naik PK, Pakam R, Midde M. Factors associated with attrition, mortality, and loss to follow up after antiretroviral therapy initiation: data from an HIV cohort study in India. Glob Health Action. 12 sept 2013; 6: 10.3402/gha.v6i0.21682.
[8]	Kiwanuka J, Mukulu Waila J, Muhindo Kahungu M, Kitonsa J, Kiwanuka N. Determinants of loss to follow-up among HIV positive patients receiving antiretroviral therapy in a test and treat setting: A retrospective cohort study in Masaka, Uganda. PLoS ONE. 7 avr 2020; 15 (4): e0217606.
[9]	Teshale AB, Tsegaye AT, Wolde HF. Incidence and predictors of loss to follow up among adult HIV patients on antiretroviral therapy in University of Gondar Comprehensive Specialized Hospital: A competing risk regression modeling. PLoS ONE. 24 janv 2020; 15 (1): e0227473.
[10]	Assemie MA, Muchie KF, Ayele TA. Incidence and predictors of loss to follow up among HIV-infected adults at Pawi General Hospital, northwest Ethiopia: competing risk regression model. BMC Res Notes. 10 mai 2018; 11: 287.
[11]	Programme national de lutte contre le Sida et les Hépatites. La Problématique des perdus de vue durant la Prise en Charge du VIH/Sida. 2019. [National AIDS and Hepatitis Control Program. The issue of lost to follow-up during HIV/AIDS Care. 2019].
[12]	Brinkhof MWG, Pujades-Rodriguez M, Egger M. Mortality of Patients Lost to Follow-Up in Antiretroviral Treatment Programmes in Resource-Limited Settings: Systematic Review and Meta-Analysis. PLoS ONE. 4 juin 2009; 4 (6): e5790.
[13]	Programme national de lutte contre le Sida et les Hépatites. Etude sur les capacités organisationnelles et fonctionnelles de 29 sites de prise en charge du VIH à grandes cohortes en Guinée. 2019. [National AIDS and Hepatitis Control Program. Study on the organizational and functional capacities of 29 large cohort HIV care sites in Guinee. 2019].
[14]	Programme national de lutte contre le Sida et les Hépatites. Modèle simplifié reproductible (MSR). 2020. [National AIDS and Hepatitis Program. Simplified repliable model (SRM). 2020].
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APA Style

Niouma Nestor Leno, Jean Michel Lamah, Foromo Guilavogui, Thierno Saidou Diallo, Youssouf Koita, et al. (2023). Incidence, Predictors and Reasons of Attrition of Patients on Antiretroviral Therapy for HIV in Eight Large-Cohort Sites in Conakry. International Journal of HIV/AIDS Prevention, Education and Behavioural Science, 9(1), 9-19. https://doi.org/10.11648/j.ijhpebs.20230901.12

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ACS Style

Niouma Nestor Leno; Jean Michel Lamah; Foromo Guilavogui; Thierno Saidou Diallo; Youssouf Koita, et al. Incidence, Predictors and Reasons of Attrition of Patients on Antiretroviral Therapy for HIV in Eight Large-Cohort Sites in Conakry. Int. J. HIV/AIDS Prev. Educ. Behav. Sci. 2023, 9(1), 9-19. doi: 10.11648/j.ijhpebs.20230901.12

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AMA Style

Niouma Nestor Leno, Jean Michel Lamah, Foromo Guilavogui, Thierno Saidou Diallo, Youssouf Koita, et al. Incidence, Predictors and Reasons of Attrition of Patients on Antiretroviral Therapy for HIV in Eight Large-Cohort Sites in Conakry. Int J HIV/AIDS Prev Educ Behav Sci. 2023;9(1):9-19. doi: 10.11648/j.ijhpebs.20230901.12

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@article{10.11648/j.ijhpebs.20230901.12,
  author = {Niouma Nestor Leno and Jean Michel Lamah and Foromo Guilavogui and Thierno Saidou Diallo and Youssouf Koita and Laye Kaba and Arnold Ahiatsi and Nagnouman Toure and Souleymane Chaloub and Andre Kamano and Mahamadou Drabo and Jean Gaudart},
  title = {Incidence, Predictors and Reasons of Attrition of Patients on Antiretroviral Therapy for HIV in Eight Large-Cohort Sites in Conakry},
  journal = {International Journal of HIV/AIDS Prevention, Education and Behavioural Science},
  volume = {9},
  number = {1},
  pages = {9-19},
  doi = {10.11648/j.ijhpebs.20230901.12},
  url = {https://doi.org/10.11648/j.ijhpebs.20230901.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijhpebs.20230901.12},
  abstract = {Introduction: The purpose of this study was to estimate the incidence of attrition (death and lost to follow-up) among patients living with HIV on ART and to identify key predictors of this attrition. It also described the reasons why some patients are lost to follow-up. Methods: This was a historical cohort study of patients living with HIV put on ART between January 1, 2015 and December 31, 2020 in 8 large cohort sites in Conakry. An additional cross-sectional survey in the form of an investigation was conducted to describe the final status of patients reported lost to follow-up by the sites, as well as to describe the reasons for their loss to follow-up. Kaplan Meier techniques were used to estimate cumulative incidence, and the multivariate Cox proportional model was used to identify predictors of attrition. Results: The cumulative incidence of attrition was 19.50 over a median follow-up time of 2.5 years, for an overall attrition rate of 7.79 years per 100 person-years. Factors significantly associated with attrition were: Age 15 - 24 years [aHR = 2.212; 95% CI (1.321 - 3.704)], age >35 years [aHR = 1.723; 95% CI (1.041 - 2.852)], viral load >100,000 copies/ml [aHR = 2.056; 95% CI (1.668 - 2.534)], patients not on the 3-month or 6-month appointment system [aHR = 3.031; 95% CI (2.603 - 3.531)]. Conclusion: This study showed that the incidence of attrition increases with increasing follow-up time. Investigation of lost to follow-up reduced the estimated number of patients considered lost to follow-up and increased the number of deaths that were previously underreported. A prospective mixed study including many more variables would allow a better understanding of the attrition phenomenon among people living with HIV on ART in Guinea.},
 year = {2023}
}

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TY  - JOUR
T1  - Incidence, Predictors and Reasons of Attrition of Patients on Antiretroviral Therapy for HIV in Eight Large-Cohort Sites in Conakry
AU  - Niouma Nestor Leno
AU  - Jean Michel Lamah
AU  - Foromo Guilavogui
AU  - Thierno Saidou Diallo
AU  - Youssouf Koita
AU  - Laye Kaba
AU  - Arnold Ahiatsi
AU  - Nagnouman Toure
AU  - Souleymane Chaloub
AU  - Andre Kamano
AU  - Mahamadou Drabo
AU  - Jean Gaudart
Y1  - 2023/01/17
PY  - 2023
N1  - https://doi.org/10.11648/j.ijhpebs.20230901.12
DO  - 10.11648/j.ijhpebs.20230901.12
T2  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
JF  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
JO  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
SP  - 9
EP  - 19
PB  - Science Publishing Group
SN  - 2575-5765
UR  - https://doi.org/10.11648/j.ijhpebs.20230901.12
AB  - Introduction: The purpose of this study was to estimate the incidence of attrition (death and lost to follow-up) among patients living with HIV on ART and to identify key predictors of this attrition. It also described the reasons why some patients are lost to follow-up. Methods: This was a historical cohort study of patients living with HIV put on ART between January 1, 2015 and December 31, 2020 in 8 large cohort sites in Conakry. An additional cross-sectional survey in the form of an investigation was conducted to describe the final status of patients reported lost to follow-up by the sites, as well as to describe the reasons for their loss to follow-up. Kaplan Meier techniques were used to estimate cumulative incidence, and the multivariate Cox proportional model was used to identify predictors of attrition. Results: The cumulative incidence of attrition was 19.50 over a median follow-up time of 2.5 years, for an overall attrition rate of 7.79 years per 100 person-years. Factors significantly associated with attrition were: Age 15 - 24 years [aHR = 2.212; 95% CI (1.321 - 3.704)], age >35 years [aHR = 1.723; 95% CI (1.041 - 2.852)], viral load >100,000 copies/ml [aHR = 2.056; 95% CI (1.668 - 2.534)], patients not on the 3-month or 6-month appointment system [aHR = 3.031; 95% CI (2.603 - 3.531)]. Conclusion: This study showed that the incidence of attrition increases with increasing follow-up time. Investigation of lost to follow-up reduced the estimated number of patients considered lost to follow-up and increased the number of deaths that were previously underreported. A prospective mixed study including many more variables would allow a better understanding of the attrition phenomenon among people living with HIV on ART in Guinea.
VL  - 9
IS  - 1
ER  -

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Author Information

Niouma Nestor Leno

Department of Public Health, Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
Jean Michel Lamah

National AIDS and Hepatitis Control Program, Conakry, Guinea
Foromo Guilavogui

African Center of Excellence for Prevention and Control of Communicable Diseases (CEA-PCMT), Faculty of Health Sciences and Techniques, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
Thierno Saidou Diallo

National AIDS and Hepatitis Control Program, Conakry, Guinea
Youssouf Koita

National AIDS and Hepatitis Control Program, Conakry, Guinea
Laye Kaba

National AIDS and Hepatitis Control Program, Conakry, Guinea
Arnold Ahiatsi

National AIDS and Hepatitis Control Program, Conakry, Guinea
Nagnouman Toure

National AIDS and Hepatitis Control Program, Conakry, Guinea
Souleymane Chaloub

NGO Doctors Without Borders of Belgium, Conakry, Guinea
Andre Kamano

NGO Doctors Without Borders of Belgium, Conakry, Guinea
Mahamadou Drabo

Faculty of Medicine, University of Aix Marseille, Marseille, France
Jean Gaudart

Faculty of Medicine, University of Aix Marseille, Marseille, France

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APA Style

Niouma Nestor Leno, Jean Michel Lamah, Foromo Guilavogui, Thierno Saidou Diallo, Youssouf Koita, et al. (2023). Incidence, Predictors and Reasons of Attrition of Patients on Antiretroviral Therapy for HIV in Eight Large-Cohort Sites in Conakry. International Journal of HIV/AIDS Prevention, Education and Behavioural Science, 9(1), 9-19. https://doi.org/10.11648/j.ijhpebs.20230901.12

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ACS Style

Niouma Nestor Leno; Jean Michel Lamah; Foromo Guilavogui; Thierno Saidou Diallo; Youssouf Koita, et al. Incidence, Predictors and Reasons of Attrition of Patients on Antiretroviral Therapy for HIV in Eight Large-Cohort Sites in Conakry. Int. J. HIV/AIDS Prev. Educ. Behav. Sci. 2023, 9(1), 9-19. doi: 10.11648/j.ijhpebs.20230901.12

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AMA Style

Niouma Nestor Leno, Jean Michel Lamah, Foromo Guilavogui, Thierno Saidou Diallo, Youssouf Koita, et al. Incidence, Predictors and Reasons of Attrition of Patients on Antiretroviral Therapy for HIV in Eight Large-Cohort Sites in Conakry. Int J HIV/AIDS Prev Educ Behav Sci. 2023;9(1):9-19. doi: 10.11648/j.ijhpebs.20230901.12

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@article{10.11648/j.ijhpebs.20230901.12,
  author = {Niouma Nestor Leno and Jean Michel Lamah and Foromo Guilavogui and Thierno Saidou Diallo and Youssouf Koita and Laye Kaba and Arnold Ahiatsi and Nagnouman Toure and Souleymane Chaloub and Andre Kamano and Mahamadou Drabo and Jean Gaudart},
  title = {Incidence, Predictors and Reasons of Attrition of Patients on Antiretroviral Therapy for HIV in Eight Large-Cohort Sites in Conakry},
  journal = {International Journal of HIV/AIDS Prevention, Education and Behavioural Science},
  volume = {9},
  number = {1},
  pages = {9-19},
  doi = {10.11648/j.ijhpebs.20230901.12},
  url = {https://doi.org/10.11648/j.ijhpebs.20230901.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijhpebs.20230901.12},
  abstract = {Introduction: The purpose of this study was to estimate the incidence of attrition (death and lost to follow-up) among patients living with HIV on ART and to identify key predictors of this attrition. It also described the reasons why some patients are lost to follow-up. Methods: This was a historical cohort study of patients living with HIV put on ART between January 1, 2015 and December 31, 2020 in 8 large cohort sites in Conakry. An additional cross-sectional survey in the form of an investigation was conducted to describe the final status of patients reported lost to follow-up by the sites, as well as to describe the reasons for their loss to follow-up. Kaplan Meier techniques were used to estimate cumulative incidence, and the multivariate Cox proportional model was used to identify predictors of attrition. Results: The cumulative incidence of attrition was 19.50 over a median follow-up time of 2.5 years, for an overall attrition rate of 7.79 years per 100 person-years. Factors significantly associated with attrition were: Age 15 - 24 years [aHR = 2.212; 95% CI (1.321 - 3.704)], age >35 years [aHR = 1.723; 95% CI (1.041 - 2.852)], viral load >100,000 copies/ml [aHR = 2.056; 95% CI (1.668 - 2.534)], patients not on the 3-month or 6-month appointment system [aHR = 3.031; 95% CI (2.603 - 3.531)]. Conclusion: This study showed that the incidence of attrition increases with increasing follow-up time. Investigation of lost to follow-up reduced the estimated number of patients considered lost to follow-up and increased the number of deaths that were previously underreported. A prospective mixed study including many more variables would allow a better understanding of the attrition phenomenon among people living with HIV on ART in Guinea.},
 year = {2023}
}

Copy | Download

TY  - JOUR
T1  - Incidence, Predictors and Reasons of Attrition of Patients on Antiretroviral Therapy for HIV in Eight Large-Cohort Sites in Conakry
AU  - Niouma Nestor Leno
AU  - Jean Michel Lamah
AU  - Foromo Guilavogui
AU  - Thierno Saidou Diallo
AU  - Youssouf Koita
AU  - Laye Kaba
AU  - Arnold Ahiatsi
AU  - Nagnouman Toure
AU  - Souleymane Chaloub
AU  - Andre Kamano
AU  - Mahamadou Drabo
AU  - Jean Gaudart
Y1  - 2023/01/17
PY  - 2023
N1  - https://doi.org/10.11648/j.ijhpebs.20230901.12
DO  - 10.11648/j.ijhpebs.20230901.12
T2  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
JF  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
JO  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
SP  - 9
EP  - 19
PB  - Science Publishing Group
SN  - 2575-5765
UR  - https://doi.org/10.11648/j.ijhpebs.20230901.12
AB  - Introduction: The purpose of this study was to estimate the incidence of attrition (death and lost to follow-up) among patients living with HIV on ART and to identify key predictors of this attrition. It also described the reasons why some patients are lost to follow-up. Methods: This was a historical cohort study of patients living with HIV put on ART between January 1, 2015 and December 31, 2020 in 8 large cohort sites in Conakry. An additional cross-sectional survey in the form of an investigation was conducted to describe the final status of patients reported lost to follow-up by the sites, as well as to describe the reasons for their loss to follow-up. Kaplan Meier techniques were used to estimate cumulative incidence, and the multivariate Cox proportional model was used to identify predictors of attrition. Results: The cumulative incidence of attrition was 19.50 over a median follow-up time of 2.5 years, for an overall attrition rate of 7.79 years per 100 person-years. Factors significantly associated with attrition were: Age 15 - 24 years [aHR = 2.212; 95% CI (1.321 - 3.704)], age >35 years [aHR = 1.723; 95% CI (1.041 - 2.852)], viral load >100,000 copies/ml [aHR = 2.056; 95% CI (1.668 - 2.534)], patients not on the 3-month or 6-month appointment system [aHR = 3.031; 95% CI (2.603 - 3.531)]. Conclusion: This study showed that the incidence of attrition increases with increasing follow-up time. Investigation of lost to follow-up reduced the estimated number of patients considered lost to follow-up and increased the number of deaths that were previously underreported. A prospective mixed study including many more variables would allow a better understanding of the attrition phenomenon among people living with HIV on ART in Guinea.
VL  - 9
IS  - 1
ER  -

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