Title

Retention on ART among HIV patients in Côte d'Ivoire and Swaziland

Presenter

Tiffany G Harris

Authors

Y. Wu¹, T.G. Harris¹, H. Brou², H.N. Kamiru³, S. Mazibuko⁴, A. Kidane³, G. Vandebriel², J.-J. M'Bea², A. Ekra⁵, A.A. Howard¹, W.M. El-Sadr¹

Institutions

¹Columbia University, ICAP, New York, United States, ²Columbia University, ICAP, Abidjan, Cote D'Ivoire, ³Columbia University, ICAP, Mbabane, Swaziland, ⁴Center for Disease Control and Prevention, Center for Global Health, Division of Global HIV/AIDs and TB, Mbabane, Swaziland, ⁵Center for Disease Control and Prevention, Center for Global Health, Division of Global HIV/AIDS and TB, Abidjan, Cote D'Ivoire

Background: The ultimate success of antiretroviral therapy (ART) initiation is dependent on achievement of high retention and adherence. Data are needed on factors that influence retention of ART patients in resource-limited settings.
Methods: We evaluated 12-month retention (PEPFAR MER indicator) among ART patients at PEPFAR-funded, ICAP-supported health facilities (HF) in Côte d''Ivoire (CI) and Swaziland (SW). By country, proportions of retained ART patients were calculated for quarterly cohorts initiating ART from January 2014-September 2015. Poisson regression models with generalized estimating equations (GEE) were used to examine time trends and significant demographic and HF factors associated with retention.
Results: Data from 6,923 HIV patients from CI (87 HF) and 19,118 from SW (93 HF) who initiated ART in this period were included in the analysis. In CI, 71.4% of patients were women and 94.2% were >15 years. Retention in CI at 12-months increased from 74.4% for the first cohort (January-March 2014) to 88.8% for the last cohort (July-September 2015), an average increase of 2.6 % per quarter after adjusting for sex, age and facility type (p_trend< 0.001). Men had lower retention than women (p< 0.0001). Patients at secondary (p< 0.0001) or tertiary (p=0.02) HF had lower retention than those at primary HF. In SW, 66.2% of patients were women and 94.3% were >15 years old. The 12-month retention was 92.7% for the first cohort and 88.2% for the last cohort, with no significant change over time (p_trend=0.34). Children 5-14 years old (p=0.001) had higher retention than adults ³15 years but children < 5 years did not (p=0.69). Patients at semi-urban HF (p=0.02) had higher retention than urban HF, while those at tertiary HF (p=0.04) had lower retention compared to primary HF.
Conclusions: Retention on ART was high in both countries compared to earlier reports from sub-Saharan Africa, with differences noted by sex, age and HF location and type. Overall, these findings are encouraging and bode well for achieving the individual and societal benefits of ART. Viral load data are needed to confirm this potential.

		Côte d''Ivoire				Swaziland
		Patients enroled	% retained	RR ratio(95% CI)	Adj.RR ratio(95%CI)	Patients enrolled	% retained	RR ratio(95%CI)	adj. RR ratio(95%CI)
Total		6,923	79.8			19,118	90.9
Sex:	Male / Female	1,978/ 4,945	76.3 / 81.2	ref 1.05(1.03,1.1)^	ref 1.06(1.03,1.1)^	6,468/ 12,650	90.2 / 91.3	ref. 1.01(0.99,1.03)
Age	<5 yrs / 5-14 yrs/ >=15 yrs	147 / 256 / 6,520	76.9 / 78.5 / 79.9	0.97(0.88,1.07) 1.01(0.94,1.08) ref	0.97(0.89,1.07) 1.0(0.94,1.08) ref	523 / 566 / 18,029	89.3 / 96.3 / 90.8	1.01(0.95,1.07) 1.1(1.03,1.15)^ ref	1.01(0.96,1.06) 1.09(1.03,1.16) ref.
Location of HF	Urban / Semi-urban / Rural	6,171 / 561 / 191	79.5 / 80.7 / 85.9	ref 1.00(0.96,1.06) 1.09(0.99,1.19)		9,738 / 2,150 / 7,230	89.0 / 95.2 / 92.1	ref. 1.1(1.01,1.14)^ 1.04(0.97,1.11)	ref. 1.1(1.01,1.14)^ 1.04(0.97,1.11)
Type of HF	Primary/ Secondary/ Tertiary/ Private	2,619 / 2,647 / 649/ 1,008	83.5 / 75.4 / 78.9/ 82.3	ref. 0.9(0.86,0.93)^ 0.94(0.9,0.99)^ 0.99(0.94,1.04)	ref. 0.9(0.85,0.93)^ 0.95(0.9,1.0)^ 1.0(0.95,1.04)	6,778 / 2,462 / 3,364 / 6,514	92.4 / 94.2 / 83.6 / 91.9	ref. 1.01(0.70,1.06) 0.9(0.80,0.99)^ 0.99(0.94,1.03)	ref. 0.99(0.95,1.03) 0.9(0.79,1.0)^ 0.98(0.92,1.04)
Time (in quarters)				2.5(1.6,3.4)%*^	2.6(1.7,3.6)%*^			-0.4(-1.1,0.3)%*	-0.4(-1.1,0.3)%*
Notes: Adj. RR=adjusted relative risk ratios from a MV model. *tranferred into % change;^p<0.05

[Table 1: 12-month retention among ART patients in ICAP supported HIV care & treatment facilities in Cote d?Ivoire and Swaziland, Jan 2014 ? Sept 2015]

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