The importance of clinic attendance in the first six months on antiretroviral treatment: a retrospective analysis at a large public sector HIV clinic in South Africa

Brennan, Alana T.; Maskew, Mhairi; Sanne, Ian; Fox, Matthew P.
January 2010
Journal of the International AIDS Society;2010, Vol. 13 Issue 1, p1
Academic Journal
Background: Adherence to care and treatment are essential for HIV-infected individuals to benefit from antiretroviral therapy (ART). We sought to quantify the effects on treatment outcomes of missing visits soon after initiating ART. Methods: We analyzed data from HIV-infected patients initiating ART at Themba Lethu Clinic, Johannesburg, South Africa, from April 2004 to August 2008. We used log-binomial regression to evaluate the relative risk of missing visits during the first six months of ART on immunological response and virologic suppression. Cox models were used to evaluate the relationship between missed visits and mortality and loss to follow up over 12 months. Results: Of 4476 patients, 65% missed no visits, while 26% missed one visit, 7% missed two and 1.6% missed three or more visits during the first six months on treatment. Patients who missed three or more medical or antiretroviral (ARV) visits had a two-fold increased risk of poor CD4 response by six months, while the risk of failing to achieve virologic suppression by six months increased two- to five-fold among patients who missed two and three or more medical or ARV visits. Adjusted Cox models showed that patients who missed two (HR 2.1; 95% CI: 1.0-4.3) and three or more (HR 4.7; 95% CI: 1.4-16.2) medical visits had an increased risk of death, while those who missed two ARV (HR 3.8; 95% CI: 2.5-5.8) or three or more medical (HR 3.0; 95% CI: 1.1-8.1) visits had an increased risk of loss to follow up. Conclusions: Thirty-five percent of patients missed one or more visits in the first six months on treatment, increasing their risk of poorer outcomes. These patients could be targeted for additional adherence counselling to help improve ART outcomes.


Related Articles

  • Operational research and HIV policy and guidelines: Lessons from a study of patients lost to follow-up from a public antiretroviral treatment program in Cameroon. Mben, Jean-Marc; Kouanfack, Charles; Essomba, Claudine Ntsama; Mbougua, Jules Brice Tchatchueng; Kenfack, Alain; Tonfack, Clément Auguste Djouatsa; Laborde-Balen, Gabrièle; Bourgeois, Anke; Biwolé-Sida, Magloire; Delaporte, Eric; Laurent, Christian // Journal of Public Health Policy;Nov2012, Vol. 33 Issue 4, p462 

    Can operations and implementation research guide today's unprecedented efforts to scale-up HIV/AIDS prevention, treatment, care, and support in resource-limited settings? Our study of patients with HIV/AIDS who were first seen at the Central Hospital (Yaoundé, Cameroon) to begin...

  • Consequences of HIV testing without consent. Obi, Samuel N.; Ifebunandu, Ngozi A. // International Journal of STD & AIDS;Feb2006, Vol. 17 Issue 2, p93 

    The objective of this study is to explore the HIV-infected individuals' experience with HIV testing, counselling, disclosure of diagnosis and subsequent life events following diagnosis. The method used is a questionnaire survey of 340 consecutive HIV-positive victims, seen in two health...

  • Immune Reconstitution Inflammatory Syndrome (IRIS) Manifesting as Anogenital HSV-2 Infection in a HIV-1-Infected Patient After Initiation of Raltegravir. Tessing, Stephanie L.; Klibanov, Olga M.; van den Berg-Wolf, Mary // Internet Journal of Infectious Diseases;2009, Vol. 7 Issue 1, p12 

    Objective: To report a case of immune reconstitution inflammatory syndrome (IRIS), manifesting as anogenital HSV-2 infection after initiation of raltegravir-based antiretroviral (ARV) therapy. Case Summary: We report a case of a 30-year-old HIV-1-infected woman, who presented to an outpatient...

  • Theory- and Evidence-Based Intervention to Improve Adherence to Antiretroviral Therapy Among HIVInfected Patients in The Netherlands: A Pilot Study. Bruin, M. De; Hospers, H.J.; Borne, H.W. Van Den; Kok, G.; Prins, J.M. // AIDS Patient Care & STDs;Jun2005, Vol. 19 Issue 6, p384 

    The objectives of this study were to describe and pilot-test a theory- and evidence-based intervention to improve adherence of HIV-infected patients with antiretroviral medication. Twenty-six treatment-experienced patients (>6 months on treatment) participated in a within-subject comparison...

  • Eighteen-year follow-up report of the surveillance and prevention of an HIV/AIDS outbreak amongst plasma donors in Hebei Province, China. Suliang Chen; Hongru Zhao; Cuiying Zhao; Yuqi Zhang; Baojun Li; Guangyi Bai; Liang Liang; Xinli Lu // BMC Infectious Diseases;Aug2015, Vol. 15 Issue 1, p1 

    Background: There has been a clear increase in HIV-1 infection cases in recent years in Hebei Province, China, and transmission via blood is one of the risk factors in the early. This article aimed to investigate the HIV infection rate and control efficiency among the paid blood donor population...

  • Cost-Effectiveness of Preventing Loss to Follow-up in HIV Treatment Programs: A Côte d'Ivoire Appraisal. Losina, Elena; Touré, Hapsatou; Uhler, Lauren M.; Anglaret, Xavier; Paltiel, A. David; Balestre, Eric; Walensky, Rochelle P.; Messou, Eugène; Weinstein, Milton C.; Dabis, François; Freedberg, Kenneth A. // PLoS Medicine;Oct2009, Vol. 6 Issue 10, p1 

    Background: Data from HIV treatment programs in resource-limited settings show extensive rates of loss to follow-up (LTFU) ranging from 5% to 40% within 6 mo of antiretroviral therapy (ART) initiation. Our objective was to project the clinical impact and cost-effectiveness of interventions to...

  • HIV/AIDS stigma and utilization of voluntary counselling and testing in Nigeria. Odimegwu, Clifford; Adedini, Sunday A.; Ononokpono, Dorothy N. // BMC Public Health;2013, Vol. 13 Issue 1, p1 

    Background: Despite the recognition of stigma as a hindrance to public health treatment and prevention there are gaps in evidence on the relationship between HIV stigma and VCT services utilization in Nigeria. The purpose of this study was to examine a community's perceptions, feelings and...

  • Youth organize for HIV counseling and testing in upper Manhattan.  // New York Amsterdam News;10/14/99, Vol. 90 Issue 42, p18 

    Reports on the HIV counseling and testing program of the Adolescent Initiative Project (AIP) of the Columbia University's Joseph L. Mailman School of Public Health in Manhattan, New York City. Holding of a recognition night on October 19, 1999; Sponsorship of the campaign by Montefiore...

  • The Case for Integrating Tuberculosis and HIV Treatment Services in South Africa. Wood, Robin // Journal of Infectious Diseases;12/2/2007, Vol. 196 Issue S3, pS497 

    Integration of human immunodeficiency virus (HIV) and tuberculosis (TB) services is critical to effectively addressing both epidemics in South Africa. Examples of the specific need to integrate TB and HIV services are presented from a community in Cape Town, South Africa, with high burdens of...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics