Retention on antiretroviral therapy and drivers of lost-to-follow up in the Central African Republic : a longitudinal analysis
Tekpa, Gaspard (Hôpital de l'Amitié (Bangui, República Centreafricana))
Inikoutiyo, Jules (Croix Rouge Française (Bangui, República Centreafricana))
Yonli, Christian (Croix Rouge Française (Bangui, República Centreafricana))
Noguera, Celia (Croix Rouge Française (Bangui, República Centreafricana))
Lujwiro, Pierre Prince (Croix Rouge Française (Bangui, República Centreafricana))
Gigout, Laure (Croix Rouge Française (Bangui, República Centreafricana))
Hachimou, Aboubacar (Croix Rouge Française (Bangui, República Centreafricana))
Romaric, Sydney (Croix Rouge Française (Bangui, República Centreafricana))
Mabaïlao, Raphaël (Ministère de la Santé et la Population de la Republique Centrafricaine (Bangui, República Centreafricana))
Banthas, M.C. (Ministère de la Santé et la Population de la Republique Centrafricaine)
Mbia, Larissa Bertille (Ministère de la Santé et la Population de la Republique Centrafricaine)
Mbay, Paulette Rose (Ministère de la Santé et la Population de la Republique Centrafricaine)
Romuald, Kevin (Ministère de la Santé et la Population de la Republique Centrafricaine)
Sana, Alain (Ministère de la Santé et la Population de la Republique Centrafricaine)
Roberte, Florida (Ministère de la Santé et la Population de la Republique Centrafricaine)
Moretó-Planas, Laura (Médecins Sans Frontières (Barcelona))
Goemaere, Eric (Médecins Sans Frontières (Cape Town, Sudàfica))
Mekiedje, Caroline (Médecins Sans Frontières (Cape Town, Sudàfica))
Ouanekpone, Stella (Médecins Sans Frontières (Barcelona))
Núñez-Andrés, María Amparo (Universitat Politècnica de Catalunya)
Hoibak, Sarah (The Global Fund to Fight AIDS)
Vallès, Xavier (Institut Germans Trias i Pujol)
Universitat Autònoma de Barcelona

Data:	2024
Resum:	Introduction: The retention in care of patients undergoing antiretroviral therapy (ART) is a cornerstone for preventing AIDS-associated morbidity and mortality, as well as further transmission of HIV. Adherence to ART poses particular challenges in conflict-affected settings like the Central African Republic (CAR). The study objective was to estimate the rate of lost-to-follow-up (LTFU) and determine factors associated with LTFU among patients living with HIV under ART in CAR. Methods: A retrospective cohort analysis was conducted using data from patients being managed at 42 representative ART dispensing sites (i. e. management of ≥200 patients) in the seven health regions of CAR which started ART between January 2019 to September 2021 and followed up to December 2021. The outcome of LTFU was defined as a failure of a patient to attend a scheduled ART refill appointment for at least 90 days from the last appointment. Patients were censored at the first LTFU event. Results: A total of 6844 patients enrolled in ART care were included in the analysis, of whom 67. 5% were females. The mean age (standard deviation) was 35. 3 years (10. 5). Forty-two per cent (n = 2874/6844) had an LTFU event during the follow-up period. However, 23. 2% (n = 666/2874) returned to care after LTFU. Overall retention in antiretroviral care at 12 months was 64. 2% (CI 63. 0-65. 5), which ranged from 76. 1% in the capital to 48. 2% in the inner country region. Risk factors related to LTFU were being male (adjusted hazard ratio [aHR] 1. 33; CI 1. 1-1. 5), age < 25 (aHR 1. 46; CI 1. 1-1. 9), living in regions outside the capital (aHR 1. 83; CI 1. 6-2. 3) and undernutrition (aHR 1. 13; CI 1. 0-1. 3). Conclusions: Retention to care in CAR is suboptimal, especially in the inner country. Our results underline the difficulties involved in retaining patients in ART in complex settings, the interplay between poor retention, social unrest, stigma, food insecurity and HIV epidemic control, and the need for tailored programming and interventions like differentiated treatment strategies and complementary food provision.
Nota:	The study was supported by Global Fund grant recipient CAF-C-CRF. We are grateful to the data collection team and health officials at CAR ARV dispensing sites and health centres for their collaboration. We are grateful as well to Karly Louie for the critical revision of the manuscript and edition.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	Journal of the International AIDS Society, Vol. 27 Núm. 12 (december 2024) , p. e26387, ISSN 1758-2652

DOI: 10.1002/jia2.26387
PMID: 39639546

13 p, 1.7 MB

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