Last data update: Jun 03, 2024. (Total: 46935 publications since 2009)
Records 1-2 (of 2 Records) |
Query Trace: Mutysia I [original query] |
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Factors associated with treatment outcomes among children and adolescents living with HIIV receiving antiretroviral therapy in central Kenya
McLigeyo A , Wekesa P , Owuor K , Mwangi J , Isavwa L , Mutysia I . AIDS Res Hum Retroviruses 2022 38 (6) 480-490 Expanded access to HIV treatment services has improved outcomes for children and adolescents living with HIV in Kenya. Minimal data are available on these outcomes. We describe temporal trends in outcomes for children and adolescents initiating antiretroviral therapy (ART) from 2004 to 2014 at sites supported by Centre for Health Solutions - Kenya in central Kenya. We retrospectively analysed data from children aged 0-9 years (n=3519) and adolescents aged 10-19 years (n=1663) living with HIV who newly initiated ART at 47 health facilities in central Kenya. Year cohorts were analysed from the Comprehensive Patient Application Database (CPAD) and International Quality Care (IQCare) electronic medical databases including temporal trends in outcomes and associated factors using multivariable competing risks regression analysis. There were more girls (2453 [52.7%]) than boys, with most enrolled at World Health Organisation (WHO) stage II (1813 [37.7%]) or III disease (1694 [35.1%]). Most of the children and adolescents (4,431 [96.4%]) did not have tuberculosis (TB) symptoms. Cumulative LTFU incidence at 6, 12, 24, and 36 months were 5.0%, 9.9%, 22.9%, and 33.1%, respectively. Cumulative mortality incidence at 6, 12, 24, and 36 months were 0.7%, 1.0%, 1.2%, and 1.5%, respectively. LTFU was higher among female children and adolescents, those initiated on tenofovir-based regimens, and those with presumptive TB symptoms. Mortality risk was higher among those with WHO stage III or IV disease, and children and adolescents on TB treatment or who had presumptive TB. Enrolment occurred at a young age and pediatric friendly ART regimens initiated at earlier WHO stages implying effective early infant diagnosis and treatment for all strategies resulting in improved treatment outcomes. The higher retention rates in recent years as well as the lower retention after many years of follow-up underscores the importance of implementing longitudinal follow-up strategies targeting this population. |
Factors Associated with Loss to Follow-up among Patients Receiving HIV Treatment in Nairobi, Kenya
Koech E , Stafford KA , Mutysia I , Katana A , Jumbe M , Awuor P , Lavoie MC , Ngunu C , Riedel DJ , Ojoo S . AIDS Res Hum Retroviruses 2021 37 (9) 642-646 OBJECTIVE: We investigated factors associated with loss to follow-up in 24 urban health facilities in Nairobi, Kenya. MATERIALS AND METHODS: We conducted a retrospective analysis of routinely collected data to assess factors associated with lost to follow-up (LTFU) in the period October 1, 2016 to June 30, 2017. LTFU was defined as no antiretroviral therapy (ART) refill for ≥90 days and no documentation of transfer, death, or treatment cessation in the patient chart, and if no lapse of ≥90 days between ART refills, patients were considered retained in care. Multivariable logistic regression modeling was used to compute odds ratios and 95% CI for LTFU. RESULTS: Our analysis included 633 individuals who were LTFU and 13,098 individuals retained in care. Most participants (69.6%) were women, and median age was 33.0 years (interquartile range, 27.2-38.3 years). Median ART duration was shorter among those LTFU (0.4 years) compared to retained patients (2.5 years, p<0.0001). Being male (adjusted odds ratio (aOR) 1.30; 95% confidence interval (CI) 1.04, 1.63, P=0.02), transferring into facilities while already receiving ART (aOR 11.58; 95% CI 8.23, 16.29, P<0.0001), and having a shorter ART duration (<6 months) were associated with increased odds of LTFU. Patients who transferred into a facility while already receiving ART had the highest adjusted odds of being LTFU compared to those retained in care. CONCLUSIONS: In this urban and highly mobile population, transferring into facilities while already receiving ART was strongly associated with LTFU. Focusing programming efforts on patients transferring between urban clinics to identify reasons for transfer and potential barriers to treatment adherence could help improve patient outcomes. Supplementary case management and support may be needed to promote a seamless transition and ensure uninterrupted engagement in HIV care and treatment. |
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