Paul Yonga1, Stephen Kalya1, Lutgarde Lynen2, Tom Decroo2,3. 1. Baringo County Referral Hospital, Ministry of Health Kenya, Kabarnet, Baringo County, P.O. BOX 67039 City Square, Postal Code, Nairobi, Kenya. 2. Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Nationalestraat 140, Postal Code, Antwerp, Belgium. 3. Research Foundation Flanders, Brussels, Belgium.
Abstract
BACKGROUND: Pastoralist communities are known to be hard to reach. The magnitude of temporary disengagement from human immunodeficiency virus (HIV) care is understudied. METHODS: We conducted a retrospective cohort study of temporary disengagement (2 weeks late for a next appointment), virologic response, lost to follow-up (6 months late) and re-engagement in care among patients who started antiretroviral therapy between 2014 and 2016 in Baringo County, Kenya. Predictors of re-engagement after disengagement were estimated using logistic regression. RESULTS: Of 342 patients, 76.9% disengaged at least once (range 0-7). Of 218 patients with a viral load (VL), 78.0% had a suppressed VL. Those with a history of temporary disengagement from care were less likely to suppress their VL (p=0.002). Six patients had treatment failure (two consecutive VLs >1000 copies/mm3) and all had disengaged at least once. After disengagement from care, male patients (adjusted odds ratio [aOR] 0.3 [95% confidence interval {CI} 0.2 to 0.6]; p<0.001) and patients with World Health Organization stage III-IV (aOR 0.3 [95% CI 0.1 to 0.5; p<0.001) were less likely to re-engage in care. CONCLUSIONS: Temporary disengagement was frequent in this pastoralist setting. This indicator is often overlooked, as most studies only report binary outcomes, such as retention in care. Innovative strategies are required to achieve HIV control in rural settings like this pastoralist setting.
BACKGROUND: Pastoralist communities are known to be hard to reach. The magnitude of temporary disengagement from human immunodeficiency virus (HIV) care is understudied. METHODS: We conducted a retrospective cohort study of temporary disengagement (2 weeks late for a next appointment), virologic response, lost to follow-up (6 months late) and re-engagement in care among patients who started antiretroviral therapy between 2014 and 2016 in Baringo County, Kenya. Predictors of re-engagement after disengagement were estimated using logistic regression. RESULTS: Of 342 patients, 76.9% disengaged at least once (range 0-7). Of 218 patients with a viral load (VL), 78.0% had a suppressed VL. Those with a history of temporary disengagement from care were less likely to suppress their VL (p=0.002). Six patients had treatment failure (two consecutive VLs >1000 copies/mm3) and all had disengaged at least once. After disengagement from care, male patients (adjusted odds ratio [aOR] 0.3 [95% confidence interval {CI} 0.2 to 0.6]; p<0.001) and patients with World Health Organization stage III-IV (aOR 0.3 [95% CI 0.1 to 0.5; p<0.001) were less likely to re-engage in care. CONCLUSIONS: Temporary disengagement was frequent in this pastoralist setting. This indicator is often overlooked, as most studies only report binary outcomes, such as retention in care. Innovative strategies are required to achieve HIV control in rural settings like this pastoralist setting.
Authors: Stella T Alamo; Robert Colebunders; Joseph Ouma; Pamela Sunday; Glenn Wagner; Fred Wabwire-Mangen; Marie Laga Journal: J Acquir Immune Defic Syndr Date: 2012-06-01 Impact factor: 3.731
Authors: Shirley Lecher; Jason Williams; Peter N Fonjungo; Andrea A Kim; Dennis Ellenberger; Guoqing Zhang; Christiane Adje Toure; Simon Agolory; Georgette Appiah-Pippim; Suzanne Beard; Marie Yolande Borget; Sergio Carmona; Geoffrey Chipungu; Karidia Diallo; Marie Downer; Dianna Edgil; Holly Haberman; Mackenzie Hurlston; Steven Jadzak; Charles Kiyaga; William MacLeod; Boniface Makumb; Hellen Muttai; Christina Mwangi; Jane W Mwangi; Michael Mwasekaga; Mary Naluguza; Lucy W Ng'Ang'A; Shon Nguyen; Souleymane Sawadogo; Katrina Sleeman; Wendy Stevens; Joel Kuritsky; Shannon Hader; John Nkengasong Journal: MMWR Morb Mortal Wkly Rep Date: 2016-12-02 Impact factor: 17.586
Authors: Carol S Camlin; Torsten B Neilands; Thomas A Odeny; Rita Lyamuya; Alice Nakiwogga-Muwanga; Lameck Diero; Mwebesa Bwana; Paula Braitstein; Geoffrey Somi; Andrew Kambugu; Elizabeth A Bukusi; David V Glidden; Kara K Wools-Kaloustian; Megan Wenger; Elvin H Geng Journal: AIDS Date: 2016-01-28 Impact factor: 4.177
Authors: Maya Petersen; Laura Balzer; Dalsone Kwarsiima; Norton Sang; Gabriel Chamie; James Ayieko; Jane Kabami; Asiphas Owaraganise; Teri Liegler; Florence Mwangwa; Kevin Kadede; Vivek Jain; Albert Plenty; Lillian Brown; Geoff Lavoy; Joshua Schwab; Douglas Black; Mark van der Laan; Elizabeth A Bukusi; Craig R Cohen; Tamara D Clark; Edwin Charlebois; Moses Kamya; Diane Havlir Journal: JAMA Date: 2017-06-06 Impact factor: 56.272
Authors: Tom Decroo; Barbara Telfer; Carla Das Dores; Richard A White; Natacha Dos Santos; Alec Mkwamba; Sergio Dezembro; Mariano Joffrisse; Tom Ellman; Carol Metcalf Journal: BMJ Open Date: 2017-08-11 Impact factor: 2.692
Authors: Matthew L Romo; Jessie K Edwards; Aggrey S Semeere; Beverly S Musick; Mark Urassa; Francesca Odhiambo; Lameck Diero; Charles Kasozi; Gad Murenzi; Patricia Lelo; Katarzyna Wyka; Elizabeth A Kelvin; Annette H Sohn; Kara K Wools-Kaloustian; Denis Nash Journal: Clin Infect Dis Date: 2022-09-10 Impact factor: 20.999