期刊
AIDS
卷 25, 期 13, 页码 1657-1661出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/QAD.0b013e32834957fd
关键词
antibiotic; HIV; lost to follow-up; prophylaxis; trimethoprim-sulfamethoxazole combination
资金
- Centers for Disease Control and Prevention (CDC) [U62/CCU024512]
- PEPFAR
- NIH [K24 HD054314, K23 AI065222, P30 AI027757]
- National Center for Research Resources, a component of NIH [TL1RR025016]
- NIAID
- NCI
- NIMH
- NIDA
- NICHD
- NHLBI
- NCCAM
Objective: To determine whether implementation of free cotrimoxazole (CTX) provision was associated with improved retention among clients ineligible for antiretroviral therapy (ART) enrolled in an HIV treatment program in Kenya. Design: Data were obtained from a clinical cohort for program evaluation purposes. Twelve-month clinic retention was compared among ART-ineligible clients enrolled in the time period before free CTX versus the time period after. Methods: Statistical comparisons were made using Kaplan-Meier survival curves, log-rank tests, and multivariate Cox proportional hazards models. To exclude potential temporal program changes that may have influenced retention, ART clients before and after the same cut-off date were compared. Findings: Among adult clients enrolled between 2005 and 2007, 3234 began ART within 1 year of enrollment, and 1024 of those who did not start treatment were defined as ART-ineligible. ART-ineligible clients enrolled in the period following free CTX provision had higher 12-month retention (84%) than those who enrolled prior to free CTX (63%; P < 0.001). Retention did not change significantly during these periods among ART clients (P - 0.55). In multivariate analysis, ART-ineligible clients enrolled prior to free CTX were more than twice as likely to be lost to follow-up compared to those following free CTX [adjusted hazard ratio (aHR) = 2.64, 95% confidence interval 1.95-3.57, P < 0.001]. Conclusion: Provision of free CTX was associated with significantly improved retention among ART-ineligible clients. Retention and CD4-monitoring of ART-ineligible clients are essential to promptly identify ART eligibility and provide treatment. Implementation of free CTX may improve retention in sub-Saharan Africa and, via increasing timely ART initiation, provide survival benefit. (C) 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
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