Evidence map›Paper›PMID 31416432›Full record

ArticleBMC public health2019

Predictors of loss to follow-up among children on long-term antiretroviral therapy in Zambia (2003-2015).

Jane N Mutanga, Simon Mutembo, Amara E Ezeamama, Xiao Song, Robert C Fubisha, Kunda Mutesu-Kapembwa, Derrick Sialondwe, Brenda Simuchembu, Jelita Chinyonga, Philip E Thuma and 1 more

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In one paragraph

Article in BMC public health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Jane N MutangaDepartment of Pediatrics and Child Health, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia. janemutanga@gmail.com.ORCID http://orcid.org/0000-0002-1951-3565
Simon MutemboDepartment of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA.
Amara E EzeamamaDepartment of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA.
Xiao SongDepartment of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA.
Robert C FubishaDepartment of Pediatrics and Child Health, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia.
Kunda Mutesu-KapembwaDepartment of Pediatrics and Child Health, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia.
Derrick SialondweDepartment of Pediatrics and Child Health, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia.
Brenda SimuchembuDepartment of Pediatrics and Child Health, Livingstone Central Hospital, Akapelwa Street, Livingstone, Zambia.
Jelita ChinyongaSouthern Province Medical Office, Ministry of Health, Choma, Zambia.
Philip E ThumaMacha Research Trust, Choma, Zambia.
Christopher C WhalenDepartment of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundRetention in care is critical for children living with HIV taking antiretroviral therapy (ART). Loss to follow-up (LTFU) is high in HIV treatment programs in resource limited settings. We estimated the cumulative incidence of LTFU and identified associated risk factors among children on ART at Livingstone Central Hospital (LCH), Zambia.

methodsUsing a retrospective cohort study design, we abstracted data from medical records of children who received ART between 2003 and 2015. Loss to follow-up was defined as no clinical and pharmacy contact for at least 90 days after the child missed their last scheduled clinical visit. Non-parametric competing risks models were used to estimate the cumulative incidence of death, LTFU and transfer. Cause-specific Cox regression was used to estimate the hazard ratios of the risk factors of LTFU.

resultsA total of 1039 children aged 0-15 years commenced ART at LCH between 2003 and 2015. Median duration of follow-up was 3.8 years (95% CI: 1.2-6.5), median age at ART initiation was 3.6 years (IQR: 1.3-8.6), 179 (17%) started treatment during their first year of life. At least 167 (16%) were LTFU and we traced 151 (90%). Of those we traced, 39 (26%) had died, 71 (47%) defaulted, 20 (13%) continued ART at other clinics and 21 (14%) continued treatment with gaps. The cumulative incidence of LTFU for the entire cohort was 2.7% (95% CI: 1.9-3.9) at 3 months, 4.1% (95% CI: 2.9-5.4) at 6 months and 14.1% (95% CI: 12.4-16.9) after 5 years on ART. Associated risk factors were: 1) non-disclosure of HIV status at baseline, aHR = 1.9 (1.2-2.9), 2) No phone ownership, aHR = 2.1 (1.6-2.9), 3) starting treatment between 2013 to 2015, aHR = 5.6 (2.2-14.1).

conclusionAmong the children LTFU mortality and default were substantially high. Children who started treatment in recent years (2013-2015) had the highest hazard of LTFU. Lack of access to a phone and non-disclosure of HIV-status to the index child was associated with higher hazards of LTFU. We recommend re-enforcement of client counselling and focused follow-up strategies using modern technology such as mobile phones as adjunct to current approaches.

Indexed as

Lost to Follow-UpAdolescentAnti-Retroviral AgentsChildChild, PreschoolFemaleHIV InfectionsHumansIncidenceInfantInfant, NewbornMaleMedical RecordsProportional Hazards ModelsRetrospective StudiesRisk FactorsAnti-Retroviral AgentsAdherenceARTHIVLoss to follow-upPediatricsRisk factors

Identifiers

PMID31416432
PMCPMC6694674

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.