Mesic, Anita, Homan, Tobias, Lenglet, Annick, Thit, Phone, Mar, Htay Thet, Sabai, Saw Myat, Thandar, Moe Pyae, Thwe, Thin Thin, Kyaw, Aung Aung, Decroo, Tom, Spina, Alexander, Ariti, Cono  ORCID: https://orcid.org/0000-0001-7615-0935, Ritmeijer, Koert, Van Olmen, Josefien, Oo, Htun Nyunt and Lynen, Lutgarde
2023.
Advanced HIV disease and associated attrition after re-engagement in HIV care in Myanmar from 2003 to 2019: a retrospective cohort study.
International Health
15
(4)
, pp. 453-461.
10.1093/inthealth/ihac069
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Abstract
Background The burden of advanced HIV disease (AHD) and predictors of outcomes among people living with HIV (PLHIV) re-engaging in care are not well known. Methods We conducted a retrospective cohort study of PLHIV who re-engaged in care after being lost to follow-up (LFU), from 2003 to 2019, in Myanmar. We calculated the incidence rates of attrition after re-engagement and performed Cox regression to identify risk factors for attrition. Results Of 44 131 PLHIV who started antiretroviral treatment, 12 338 (28.0%) were LFU at least once: 7608 (61.6%) re-engaged in care, 4672 (61.4%) with AHD at re-engagement. The death and LFU rates were 2.21-fold (95% CI 1.82 to 2.67) and 1.46-fold (95% CI 1.33 to 1.61) higher among patients who re-engaged with AHD (p>0.001). Death in patients who re-engaged with AHD was associated with male sex (adjusted HR [aHR] 2.63; 95% CI 1.31 to 5.26; p=0.006), TB coinfection (aHR 2.26; 95% CI 1.23 to 4.14; p=0.008) and sex work (aHR 7.49, 95% CI 2.29 to 22.52; p<0.001). History of intravenous drug use was identified as a predictor of being LFU. Conclusions Re-engagement in HIV care in Myanmar is frequent and those who re-engage carry a high burden of AHD. As AHD at re-engagement is associated with higher attrition rates, implementation of differentiated interventions that enable earlier linkage to care and prompt identification and management of AHD in this population is necessary.
| Item Type: | Article |
|---|---|
| Date Type: | Publication |
| Status: | Published |
| Schools: | Schools > Medicine Research Institutes & Centres > Centre for Trials Research (CNTRR) |
| Publisher: | Oxford University Press |
| ISSN: | 1876-3413 |
| Funders: | The work was funded through the operational budget of Medecins Sans Frotieres |
| Date of First Compliant Deposit: | 18 January 2023 |
| Date of Acceptance: | 12 October 2022 |
| Last Modified: | 16 Aug 2023 16:45 |
| URI: | https://orca.cardiff.ac.uk/id/eprint/156072 |
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