ABSTRACT
BACKGROUND: Retaining patients in clinical care is necessary to ensure successful antiretroviral treatment (ART) outcomes. Among patients who discontinue care, some reenter care at a later stage, whereas others are or will be lost from follow-up. We examined risk factors for health care interruptions and loss to follow-up within a cohort receiving ART in Uganda. METHODS: Using a large hospital cohort providing free universal ART and HIV clinical care, we assessed characteristics and risk factors for treatment interruptions, defined as a 12-month absence from care at Mildmay, and loss to follow-up, defined as absence from care greater than 12 months without reengagement in care at Mildmay. We included patients aged 14 years and above. We assessed these outcomes over time using Kaplan-Meier analysis and multivariable regression. RESULTS: Of 6970 eligible patients, 784 (11.2%) had a health care interruption of at least 12 months and 217 (3.1%) were lost to follow-up. Patients experiencing health care interruptions had higher baseline CD4 T-cell counts at ART initiation, defined as ≥ 250 cells per cubic millimeter [odds ratio (OR): 1.29, 95% confidence intervals (CI): 1.11 to 1.50], and lower levels of education (OR: 1.32, 95% CI: 1.09 to 1.61). Adolescents were much more likely to be lost to follow-up (OR: 3.11, 95% CI: 2.23 to 4.34). In contrast, having a partner (OR: 0.22, 95% CI: 0.16 to 0.31) or being sexually active at baseline (OR: 0.40, 95% CI: 0.28 to 0.55) was protective of loss to follow-up. CONCLUSIONS: Within this cohort, long periods of unsupervised health care interruptions were common.
Subject(s)
Anti-HIV Agents/therapeutic use , HIV Infections/drug therapy , Medication Adherence/statistics & numerical data , Adult , Antiretroviral Therapy, Highly Active , CD4 Lymphocyte Count , Cohort Studies , Female , Humans , Lost to Follow-Up , Male , Risk Factors , Time Factors , Treatment Outcome , UgandaABSTRACT
Despite high reported coverage for routine and supplementary immunization, in 2010 in Malawi, a large measles outbreak occurred that comprised 134,000 cases and 304 deaths. Although the highest attack rates were for young children (2.3%, 7.6%, and 4.5% for children <6, 6-8, and 9-11 months, respectively), persons >15 years of age were highly affected (1.0% and 0.4% for persons 15-19 and >19 years, respectively; 28% of all cases). A survey in 8 districts showed routine coverage of 95.0% for children 12-23 months; 57.9% for children 9-11 months; and 60.7% for children covered during the last supplementary immunization activities in 2008. Vaccine effectiveness was 83.9% for 1 dose and 90.5% for 2 doses. A continuous accumulation of susceptible persons during the past decade probably accounts for this outbreak. Countries en route to measles elimination, such as Malawi, should improve outbreak preparedness. Timeliness and the population chosen are crucial elements for reactive campaigns.
Subject(s)
Disease Outbreaks/prevention & control , Measles/prevention & control , Adolescent , Adult , Child , Child, Preschool , Developing Countries , Epidemiological Monitoring , Female , Humans , Immunity , Incidence , Infant , Malawi/epidemiology , Male , Mass Vaccination , Measles/immunology , Measles/mortality , Measles Vaccine , Young AdultABSTRACT
Mildmay Uganda (MUg), an HIV treatment centre near Kampala, the capital of Uganda, has entered into a memorandum of understanding to collaborate with Canadian researchers at the University of Ottawa to develop their research programme and develop an observational cohort database (the MUg observational cohort). The primary objectives of the MUg observational cohort are to monitor clinical care and outcomes of HIV among patients on treatment and to bring awareness to trends that are functional and dysfunctional in HIV care in Uganda. The MUg observational cohort comprises 8835 individuals who initiated combination antiretroviral therapy at MUg between January 2004 and October 2011. There are considerably more women (63.2%) than men in the cohort, and age spans from newborn to 92 years old. The low median age of 31 years (interquartile range: 18-38 years) can be explained by the 24.9% of the cohort aged <18 years. The median baseline CD4 cell count among the entire cohort is 172 cells/mm(3) (interquartile range: 73-249 cells/mm(3)). Data are routinely completed at treatment initiation, and follow-up data are collected routinely through physician visits and laboratory results. Data comprise demographic, behavioural and clinical variables. Collaborations and enquiries relating to the MUg observational cohort are encouraged, and can be addressed to Dr Edward Mills at edward.mills@uottowa.ca.
