Retention and Predictors of Attrition Among People Living With HIV on Antiretroviral Therapy in Guinea: A 13-Year Historical Cohort Study in Nine Large-Volume Sites

Int J Public Health. 2023 Jul 13:68:1605929. doi: 10.3389/ijph.2023.1605929. eCollection 2023.

Abstract

Objectives: The objective of this study was to estimate the retention rate of patients in an ART program and identify the predictors of attrition. Methods: This was a historical cohort study of HIV patients who started ART between September 2007 and April 2020, and were followed up on for at least 6 months in nine large-volume sites. Kaplan Meier techniques were used to estimate cumulative retention and attrition probabilities. Cox proportional hazards models were used to identify predictors of attrition. Results: The cumulative probability of retention at 12 and 24 months was 76.2% and 70.2%, respectively. The attrition rate after a median follow-up time of 3.1 years was 35.2%, or an incidence of 11.4 per 100 person-years. Having initiated ART between 2012 and 2015; unmarried status; having initiated ART with CD4 count <100 cells/μL; and having initiated ART at an advanced clinical stage were factors significantly associated with attrition. Conclusion: The retention rate in our study is much lower than the proposed national target (90%). Studies to understand the reasons for loss to follow-up are needed.

Keywords: HIV/AIDS; antiretroviral therapy; attrition; predictors; retention.

MeSH terms

  • Anti-HIV Agents* / therapeutic use
  • CD4 Lymphocyte Count
  • Cohort Studies
  • Guinea
  • HIV Infections* / drug therapy
  • HIV Infections* / epidemiology
  • Humans
  • Proportional Hazards Models
  • Retrospective Studies

Substances

  • Anti-HIV Agents

Grants and funding

This study was conducted as part of the work of a PhD and as part of the evaluation of routine services of the National AIDS and Hepatitis Control Program of the Republic of Guinea. The publication fees were paid by the African Center of Excellence for the Prevention and Control of Communicable Diseases of the Gamal Abdel Nasser University of Conakry. This center is funded by the World Bank.