Browsing by Subject "Lost to follow-up"

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    “A problem shared is half solved” – A qualitative assessment of barriers and facilitators to adolescent retention in HIV care in western Kenya
    (Taylor & Francis, 2020-01) Enane, Leslie A.; Apondi, Edith; Toromo, Judith; Bosma, Christopher; Ngeresa, Antony; Nyandiko, Winstone; Vreeman, Rachel C.; Pediatrics, School of Medicine
    Adolescents living with HIV (ALHIV, ages 10-19) are retained in care at low rates, resulting in poor clinical outcomes. We sought to define barriers and facilitators to retention experienced by perinatally-infected ALHIV in western Kenya. This qualitative study purposefully sampled hospitalized ALHIV (both engaged and not currently engaged in care), ALHIV engaged in outpatient care, and caregivers of ALHIV. In total, 116 ALHIV and caregivers participated in interviews or focus group discussions. Complex challenges related to the effects of both stigma and poverty at multiple socio-ecological levels pose the greatest barriers to adolescent retention in HIV care. Adolescents with positive relationships with family, clinic, and/or peers with the resources to support their care are facilitated to overcome these barriers. Conversely, adolescents with few of these supports due to orphanhood, caregiver illness, severe poverty, family conflicts, negative relationships with healthcare workers, or isolation, have the greatest challenges staying in care, and may be at risk of disengagement. Emerging from narratives of disengagement are experiences of trauma, which contribute to isolation, mental health challenges, and difficulties engaging in care. Retention of the most vulnerable adolescents will require interventions to mitigate the impacts of stigma, poverty, mental health issues, and limited social support on their engagement in HIV care.
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    Site-Level Comprehensiveness of Care Is Associated with Individual Clinical Retention Among Adults Living with HIV in International Epidemiology Databases to Evaluate AIDS, a Global HIV Cohort Collaboration, 2000-2016
    (Mary Ann Liebert, 2022) Wada, Paul Y.; Kim, Ahra; Jayathilake, Karu; Duda, Stephany N.; Abo, Yao; Althoff, Keri N.; Cornell, Morna; Musick, Beverly; Brown, Steve; Sohn, Annette H.; Chan, Yu Jiun; Wools-Kaloustian, Kara K.; Nash, Denis; Yiannoutsos, Constantin T.; Cesar, Carina; McGowan, Catherine C.; Rebeiro, Peter F.; Biostatistics and Health Data Science, School of Medicine
    Retention in care (RIC) reduces HIV transmission and associated morbidity and mortality. We examined whether delivery of comprehensive services influenced individual RIC within the International epidemiology Databases to Evaluate AIDS (IeDEA) network. We collected site data through IeDEA assessments 1.0 (2000–2009) and 2.0 (2010–2016). Each site received a comprehensiveness score for service availability (1 = present, 0 = absent), with tallies ranging from 0 to 7. We obtained individual-level cohort data for adults with at least one visit from 2000 to 2016 at sites responding to either assessment. Person-time was recorded annually, with RIC defined as completing two visits at least 90 days apart in each calendar year. Multivariable modified Poisson regression clustered by site yielded risk ratios and predicted probabilities for individual RIC by comprehensiveness. Among 347,060 individuals in care at 122 sites with 1,619,558 person-years of follow-up, 69.8% of person-time was retained in care, varying by region from 53.8% (Asia-Pacific) to 82.7% (East Africa); RIC improved by about 2% per year from 2000 to 2016 (p = 0.012). Every site provided CD4+ count testing, and >90% of individuals received care at sites that provided combination antiretroviral therapy adherence measures, prevention of mother-to-child transmission, tuberculosis screening, HIV-related prevention, and community tracing services. In adjusted models, individuals at sites with more comprehensive services had higher probabilities of RIC (0.71, 0.74, and 0.83 for scores 5, 6, and 7, respectively; p = 0.019). Within IeDEA, greater site-level comprehensiveness of services was associated with improved individual RIC. Much work remains in exploring this relationship, which may inform HIV clinical practice and health systems planning.