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
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...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2010-01-01
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| Series: | Journal of the International AIDS Society |
| Online Access: | https://doi.org/10.1186/1758-2652-13-49 |
| _version_ | 1797894776603803648 |
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| author | Alana T Brennan Mhairi Maskew Ian Sanne Matthew P Fox |
| author_facet | Alana T Brennan Mhairi Maskew Ian Sanne Matthew P Fox |
| author_sort | Alana T Brennan |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-04-10T07:14:45Z |
| format | Article |
| id | doaj.art-0e5c2d83b9364212b8c97f1e727fb2fd |
| institution | Directory Open Access Journal |
| issn | 1758-2652 |
| language | English |
| last_indexed | 2024-04-10T07:14:45Z |
| publishDate | 2010-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the International AIDS Society |
| spelling | doaj.art-0e5c2d83b9364212b8c97f1e727fb2fd2023-02-25T12:30:34ZengWileyJournal of the International AIDS Society1758-26522010-01-01131494910.1186/1758-2652-13-49The importance of clinic attendance in the first six months on antiretroviral treatment: a retrospective analysis at a large public sector HIV clinic in South AfricaAlana T Brennan0Mhairi Maskew1Ian Sanne2Matthew P Fox3Center for Global Health and Development, Boston University, Boston, MA, USAClinical HIV Research Unit, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, South AfricaRight to Care, Johannesburg, South AfricaCenter for Global Health and Development, Boston University, Boston, MA, USABackground 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.https://doi.org/10.1186/1758-2652-13-49 |
| spellingShingle | Alana T Brennan Mhairi Maskew Ian Sanne Matthew P Fox 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 |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| url | https://doi.org/10.1186/1758-2652-13-49 |
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