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Disengagement from HIV care and failure of second-line therapy in Nigeria: a retrospective cohort study, 2005-2017

El Bouzidi, Kate; Murtala-Ibrahim, Fati; Kwaghe, Vivian; Datir, Rawlings P; Ogbanufe, Obinna; Crowell, Trevor A; Charurat, Man; ... Sabin, Caroline A; + view all (2022) Disengagement from HIV care and failure of second-line therapy in Nigeria: a retrospective cohort study, 2005-2017. JAIDS: Journal of Acquired Immune Deficiency Syndromes , 90 (1) pp. 88-96. 10.1097/QAI.0000000000002918. Green open access

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Abstract

BACKGROUND: Understanding the correlates of disengagement from HIV care and treatment failure during second-line antiretroviral therapy (ART) could inform interventions to improve clinical outcomes among people living with HIV (PLHIV). METHODS: We conducted a retrospective cohort study of PLHIV aged >15 years who started second-line ART at a tertiary centre in Nigeria between 2005 and 2017. Participants were considered to have disengaged from care if they had not returned within a year after each clinic visit. Cox proportional hazards models were used to investigate factors associated with: i) viral failure (HIV-1 RNA >1,000 copies/mL), ii) immunologic failure (CD4 count decrease or <100 cells/mm3), and iii) severe weight loss (>10% of bodyweight), after >6 months of second-line ART. RESULTS: Among 1031 participants, 33% (341) disengaged from care during a median follow-up of 6.9 years (IQR 3.7-8.5). Of these, 26% (89/341) subsequently re-entered care. Disengagement was associated with male gender, age <30, lower education level and low CD4 count at second-line ART initiation. Among participants with endpoint assessments available, 20% (112/565) experienced viral failure, 32% (257/809) experienced immunologic failure, and 23% (190/831) experienced weight loss. A lower risk of viral failure was associated with professional occupations compared to elementary: adjusted hazard ratio 0.17 (95% confidence interval 0.04-0.70). CONCLUSION: Adverse outcomes were common during second-line ART. However, re-engagement is possible and resources should be allocated to focus on retaining PLHIV in care and providing services to trace and re-engage those who have disengaged from care.

Type: Article
Title: Disengagement from HIV care and failure of second-line therapy in Nigeria: a retrospective cohort study, 2005-2017
Location: United States
Open access status: An open access version is available from UCL Discovery
DOI: 10.1097/QAI.0000000000002918
Publisher version: http://doi.org/10.1097/QAI.0000000000002918
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
URI: https://discovery.ucl.ac.uk/id/eprint/10142891
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