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Advanced HIV disease and associated attrition after re-engagement in HIV care in Myanmar from 2003 to 2019: a retrospective cohort study

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:, 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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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: Medicine
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

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