Barcelona 2013
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| Abstract #503 - Health Care Provision | ||||
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Session: 33.1: Health Care Provision (Parallel) on Tuesday @ 14.30-16.00 in Teatre Chaired by Araceli Rousaud, Sheana Bull Authors: Presenting Author: Dr.* Daniel Reijer - AIDS Healthcare Foundation, Netherlands |
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| Additional Authors: Sra. Rosa de Dios, Sra. Lourdes Mestres, Sra. Alicia Lluva, | ||||
| Aim: Much research has focused on daily adherence to antiretroviral therapy (ART) while less attention has been given to the long-term retention of patients in treatments programs. In recent years more work has been published about retention of ART clients in sub-Saharan Africa but analysis in other regions, particularly Asia, is less well described. The objective of this study is to ascertain retention rates and analyze the ART cascade of care among clients receiving ART in Phnom Penh, Cambodia. | ||||
| Method / Issue: A retrospective cohort analysis of clients who received ART at the Preah Kossamak HIV clinic from January 2004 to March 2008 (n=1196) was conducted to examine client retention rates. The rate of retention was defined as the proportion of clients remaining alive and on ART after ART initiation. Retention rates were examined at six-month intervals during the 60-month period after ART initiation. We focused only on treatment naïve patients and excluded all clients who transferred out to other ART facilities. | ||||
| Results / Comments: Retention at 60 months was 85.8%. Attrition was highest in the first six-months, when 4.6% of initiated clients died or were lost to follow-up (LTFU defined as not visiting the site for >90 days), this represents over a quarter (28.9%) of all deaths and LTFU that occurred in the 60 months following initiation. Among clients who died within the first six months there was an average CD4 count of 34.9 cells/mm3 (95% CI = 20.15 to 50.15) compared to an average of 49.8 cells/mm3 (95% CI = 43.82 to 55.76) for all deaths and 102.8 cells/mm3 among active clients (95% CI = 97.48 to 108.24). There were slight decreases in retention over the study period with a retention rate of 93.4% at twelve months, which declined to 89% at 36 months and 85.8% at 60 months. No clients initiated interrupted or halted their ART usage during the study period. | ||||
| Discussion: The analysis showed a strong correlation between a low CD4 count when initiating ART and death. Many of the clients with low CD4 counts died or were LTFU while clients with higher CD4 counts were more likely to remain in care and treatment. The high number of patients that died within the first six months indicates that patients were initiated on ART late. Earlier initiation would have prevented many deaths and would have improved retention further. The retention rate found is high and this may be partly attributed to the fact that many of the clinic?s clients paid for care and treatment before the hospital?s services became free-of-charge in 2004.Clients seeking and paying for care and treatment are likely to be more committed to adhering to treatment. This may be one of the explanations for the high retention rates found. | ||||
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