ArticleGlobal health action
Alarming attrition rates among HIV-infected individuals in pre-antiretroviral therapy care in Myanmar, 2011-2014.
Article in Global health action. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- Prevalence of anemia among people living with HIV: A systematic review and meta-analysis.EClinicalMedicine · 2022Article
- Antiretroviral therapy (ART) coverage at public and private ART facilities in Myanmar.AIDS care · 2021Article
- A 17 year experience of attrition from care among HIV infected children in Nnewi South-East Nigeria.BMC infectious diseases · 2021Article
- Early Success With Retention in Care Among People Living With HIV at Decentralized ART Satellite Sites in Yangon, Myanmar, 2015-2016.Frontiers in public health · 2019Article
- Attrition among HIV positive children enrolled under integrated HIV care programme in Myanmar: 12 years cohort analysis.Global health action · 2018Article
- Time to anti-retroviral therapy among people living with HIV enrolled into care in Myanmar: how prepared are we for 'test and treat'?Global health action · 2018Article
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Abstract
backgroundHigh retention rates have been documented among patients receiving antiretroviral therapy (ART) in Myanmar. However, there is no information on human immunodeficiency virus (HIV)-infected individuals in care before initiation of ART (pre-ART care). We assessed attrition (loss-to-follow-up [LTFU] and death) rates among HIV-infected individuals in pre-ART care and their associated factors over a 4-year period.
designIn this retrospective cohort study, we extracted routinely collected data of HIV-infected adults (>15 years old) entering pre-ART care (June 2011-June 2014) as part of an Integrated HIV Care (IHC) programme, Myanmar. Attrition rates per 100 person-years and cumulative incidence of attrition were calculated. Factors associated with attrition were examined by calculating hazard ratios (HRs).
resultsOf 18,037 HIV-infected adults enrolled in the IHC programme, 11,464 (63%) entered pre-ART care (60% men, mean age 37 years, median cluster of differentiation 4 (CD4) cell count 160 cells/µL). Of the 11,464 eligible participants, 3,712 (32%) underwent attrition of which 43% were due to deaths and 57% were due to LTFU. The attrition rate was 78 per 100 person-years (95% CI, 75-80). The cumulative incidence of attrition was 70% at the end of a 4-year follow-up, of which nearly 90% occurred in the first 6 months. Male sex (HR 1.5, 95% CI 1.4-1.6), WHO clinical Stage 3 and 4, CD4 count <200 cells/µL, abnormal BMI, and anaemia were statistically significant predictors of attrition.
conclusionsPre-ART care attrition among persons living with HIV in Myanmar was alarmingly high - with most attrition occurring within the first 6 months. Strategies aimed at improving early HIV diagnosis and initiation of ART are needed. Suggestions include comprehensive nutrition support and intensified monitoring to prevent pre-ART care attrition by tracking patients who do not return for pre-ART care appointments. It is high time that Myanmar moves towards a 'test and treat' approach and ultimately eliminates the need for pre-ART care.
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