OBJECTIVE: To determine whether implementation of free cotrimoxazole (CTX) provision was associated with improved retention among clients ineligible for antiretroviral therapy (ART) enrolled in an HIV treatment program in Kenya. DESIGN: Data were obtained from a clinical cohort for program evaluation purposes. Twelve-month clinic retention was compared among ART-ineligible clients enrolled in the time period before free CTX versus the time period after. METHODS: Statistical comparisons were made using Kaplan-Meier survival curves, log-rank tests, and multivariate Cox proportional hazards models. To exclude potential temporal program changes that may have influenced retention, ART clients before and after the same cut-off date were compared. FINDINGS: Among adult clients enrolled between 2005 and 2007, 3234 began ART within 1 year of enrollment, and 1024 of those who did not start treatment were defined as ART-ineligible. ART-ineligible clients enrolled in the period following free CTX provision had higher 12-month retention (84%) than those who enrolled prior to free CTX (63%; P < 0.001). Retention did not change significantly during these periods among ART clients (P = 0.55). In multivariate analysis, ART-ineligible clients enrolled prior to free CTX were more than twice as likely to be lost to follow-up compared to those following free CTX [adjusted hazard ratio (aHR) = 2.64, 95% confidence interval 1.95-3.57, P < 0.001]. CONCLUSION: Provision of free CTX was associated with significantly improved retention among ART-ineligible clients. Retention and CD4-monitoring of ART-ineligible clients are essential to promptly identify ART eligibility and provide treatment. Implementation of free CTX may improve retention in sub-Saharan Africa and, via increasing timely ART initiation, provide survival benefit.
OBJECTIVE: To determine whether implementation of free cotrimoxazole (CTX) provision was associated with improved retention among clients ineligible for antiretroviral therapy (ART) enrolled in an HIV treatment program in Kenya. DESIGN: Data were obtained from a clinical cohort for program evaluation purposes. Twelve-month clinic retention was compared among ART-ineligible clients enrolled in the time period before free CTX versus the time period after. METHODS: Statistical comparisons were made using Kaplan-Meier survival curves, log-rank tests, and multivariate Cox proportional hazards models. To exclude potential temporal program changes that may have influenced retention, ART clients before and after the same cut-off date were compared. FINDINGS: Among adult clients enrolled between 2005 and 2007, 3234 began ART within 1 year of enrollment, and 1024 of those who did not start treatment were defined as ART-ineligible. ART-ineligible clients enrolled in the period following free CTX provision had higher 12-month retention (84%) than those who enrolled prior to free CTX (63%; P < 0.001). Retention did not change significantly during these periods among ART clients (P = 0.55). In multivariate analysis, ART-ineligible clients enrolled prior to free CTX were more than twice as likely to be lost to follow-up compared to those following free CTX [adjusted hazard ratio (aHR) = 2.64, 95% confidence interval 1.95-3.57, P < 0.001]. CONCLUSION: Provision of free CTX was associated with significantly improved retention among ART-ineligible clients. Retention and CD4-monitoring of ART-ineligible clients are essential to promptly identify ART eligibility and provide treatment. Implementation of free CTX may improve retention in sub-Saharan Africa and, via increasing timely ART initiation, provide survival benefit.
Authors: Katie Tayler-Smith; Rony Zachariah; Moses Massaquoi; Marcel Manzi; Olesi Pasulani; Thomas van den Akker; Marielle Bemelmans; Ariane Bauernfeind; Beatrice Mwagomba; Anthony D Harries Journal: Trans R Soc Trop Med Hyg Date: 2010-02-06 Impact factor: 2.184
Authors: Margaret May; Andrew Boulle; Sam Phiri; Eugene Messou; Landon Myer; Robin Wood; Olivia Keiser; Jonathan A C Sterne; Francois Dabis; Matthias Egger Journal: Lancet Date: 2010-07-15 Impact factor: 79.321
Authors: Michael H Chung; Alison L Drake; Barbra A Richardson; Ashok Reddy; Joan Thiga; Samah R Sakr; James N Kiarie; Paul Yowakim; Grace C John-Stewart Journal: Curr HIV Res Date: 2009-07 Impact factor: 1.581
Authors: Martin W G Brinkhof; François Dabis; Landon Myer; David R Bangsberg; Andrew Boulle; Denis Nash; Mauro Schechter; Christian Laurent; Olivia Keiser; Margaret May; Eduardo Sprinz; Matthias Egger; Xavier Anglaret Journal: Bull World Health Organ Date: 2008-07 Impact factor: 9.408
Authors: Elena Losina; Ingrid V Bassett; Janet Giddy; Senica Chetty; Susan Regan; Rochelle P Walensky; Douglas Ross; Callie A Scott; Lauren M Uhler; Jeffrey N Katz; Helga Holst; Kenneth A Freedberg Journal: PLoS One Date: 2010-03-04 Impact factor: 3.240
Authors: Máirín Ryan; Susan Griffin; Bona Chitah; A Sarah Walker; Veronica Mulenga; Donald Kalolo; Neil Hawkins; Concepta Merry; Michael G Barry; Chifumbe Chintu; Mark J Sculpher; Diana M Gibb Journal: AIDS Date: 2008-03-30 Impact factor: 4.177
Authors: Bruce A Larson; Alana Brennan; Lynne McNamara; Lawrence Long; Sydney Rosen; Ian Sanne; Matthew P Fox Journal: Trop Med Int Health Date: 2010-06 Impact factor: 2.622
Authors: Larry W Chang; Gertrude Nakigozi; Veena G Billioux; Ronald H Gray; David Serwadda; Thomas C Quinn; Maria J Wawer; Robert C Bollinger; Steven J Reynolds Journal: AIDS Behav Date: 2015-10
Authors: Catrina Mugglin; Janne Estill; Gilles Wandeler; Nicole Bender; Matthias Egger; Thomas Gsponer; Olivia Keiser Journal: Trop Med Int Health Date: 2012-09-20 Impact factor: 2.622
Authors: Kirsten Smillie; Natasha Van Borek; Mia L van der Kop; Abigael Lukhwaro; Neville Li; Sarah Karanja; Anik R Patel; David Ojakaa; Richard T Lester Journal: Afr J AIDS Res Date: 2014 Impact factor: 1.300
Authors: Larry W Chang; David Serwadda; Thomas C Quinn; Maria J Wawer; Ronald H Gray; Steven J Reynolds Journal: Lancet Infect Dis Date: 2013-01 Impact factor: 25.071