The IeDEA West Africa Adults Group is constituted as follows: Primary investigators: Pr François Dabis* (INSERM U897, ISPED, Bordeaux, France), Emmanuel Bissagnene* (SMIT, CHU de Treichville, Abidjan, Côte d’Ivoire); Co-investigators: Clarisse Amani-Bosse, Franck Olivier Ba-Gomis, Emmanuel Bissagnene*, Man Charurat*, Eric Delaporte, Joseph Drabo*, Serge-Paul Eholie*, Serge-Olivier Koulé, Moussa Maiga*, Eugène Messou, Albert Minga, Kevin Peterson, Papa Salif Sow, Hamar Traoré, Marcel D Zannou*; Other members: Gérard Allou, Xavier Anglaret, Alain Azondékon, Eric Balestre, Jules Bashi, Ye-Diarra, Didier K Ekouévi*, Jean-François Eytard, Antoine Jaquet, Alain Kouakoussui, Valériane Leroy, Charlotte Lewden, Karen Malateste, Lorna Renner, Annie Sasco, Haby Signaté Sy*, Rodolphe Thiebault, Marguerite Timité-Konan, Hapsatou Touré. Adult Clinical centres: Service de Médecine Interne et Tropicale (SMIT), CHU de Treichville, Abidjan, Côte d’Ivoire; Unité de Soins Ambulatoires et de Conseil (USAC), Abidjan, Côte d’Ivoire; Centre Médical de Suivi de Donneurs de Sang/CNTS/PRIMO-CI, Abidjan, Côte d’Ivoire; ACONDA-MTCT-Plus, Abidjan, Côte d’Ivoire; ACONDA-CePReF, Abidjan Côte d’Ivoire; Centre Intégré de Recherche Bioclinique d’Abidjan (CIRBA), Abidjan, Côte d’Ivoire; Service des Maladies Infectieuses, CHU de FANN/ISAARV, Dakar, Sénégal; ANRS 1215 Cohort, Dakar, Senegal; Service d’Hépato-Gastro-Entérologie, Hôpital Gabriel Touré, Bamako, Mali; Centre de Prise en Charge des Personnes vivant avec le VIH, Hôpital du Point G, Bamako, Mali; Fajara Cohort, Banjul, Gambia; Service de Médecine Interne, CNHU Hubert Maga, Cotonou, Benin; Service de Médecine Interne, CHU Yalgado, Ouagadougou, Burkina-Faso. Coordinating centres: Programme PAC-CI, CHU de Treichville, Abidjan, Côte d’Ivoire; ISPED, Université Victor Segalen Bordeaux 2, France. *IeDEA West Africa Technical Committee member.
Low retention of HIV-infected patients on antiretroviral therapy in 11 clinical centres in West Africa
Article first published online: 29 APR 2010
© 2010 Blackwell Publishing Ltd
Tropical Medicine & International Health
Special Issue: Retention of patients in HIV/AIDS care and treatment programs in sub-Saharan Africa
Volume 15, Issue Supplement s1, pages 34–42, June 2010
How to Cite
Ekouevi, D. K., Balestre, E., Ba-Gomis, F.-O., Eholie, S. P., Maiga, M., Amani-Bosse, C., Minga, A., Messou, E., Sow, P. S., Lewden, C., Traoré, H. A., Bissagnene, E., Dabis, F. and for the IeDEA West Africa Collaboration (2010), Low retention of HIV-infected patients on antiretroviral therapy in 11 clinical centres in West Africa. Tropical Medicine & International Health, 15: 34–42. doi: 10.1111/j.1365-3156.2010.02505.x
- Issue published online: 29 APR 2010
- Article first published online: 29 APR 2010
- cohort studies;
- HIV infection;
- West Africa;
- loss to follow-up
Objective To study factors associated with the probability of retention in antiretroviral therapy (ART) programmes in West Africa.
Methods The International epidemiologic Databases to Evaluate AIDS (IeDEA) in West Africa is a prospective, operational, observational cohort study based on collaboration between 11 cohorts of HIV-infected adult patients in Benin, Côte d’Ivoire, Gambia, Mali and Senegal. All patients aged 16 and older at ART initiation, with documented gender and date of ART initiation, were included. For those with at least 1 day of follow-up, Kaplan–Meier method and Weibull regression model were used to estimate the 12-month probability of retention in care and the associated factors.
Results In this data merger, 14 352 patients (61% female) on ART were included. Median age was 37 (interquartile range (IQR): 31–44 years) and median CD4 count at baseline was 131 cells/mm3 (IQR: 48–221 cells/mm3). The first-line regimen was NNRTI-based for 78% of patients, protease inhibitor-based for 17%, and three NRTIs for 3%. The probability of retention was 0.90 [95% confidence interval (CI): 0.89–0.90] at 3 months, 0.84 (95% CI: 0.83–0.85) at 6 months and 0.76 (95% CI: 0.75–0.77) at 12 months. The probability of retention in care was lower in patients with baseline CD4 count <50 cells/mm3 [adjusted hazard ratio (aHR) = 1.37; 95% CI: 1.27–1.49; P < 0.0001] (reference CD4 > 200 cells/mm3, in men (aHR = 1.17; 95% CI: 1.10–1.24; P = 0.0002), in younger patients (<30 years) (aHR = 1.10; 95% CI: 1.03–1.19; P = 0.01) and in patients with low haemoglobinaemia <8 g/dl (aHR = 1.33; 95% CI: 1.21–1.45; P < 0.0001). Availability of funds for systematic tracing was associated with better retention (aHR = 0.29; 95% CI: 0.16–0.55; P = 0.001).
Conclusions Close follow-up, promoting early access to care and ART and a decentralized system of care may improve the retention in care of HIV-infected patients on ART.