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Factores de riesgo en la no aceptación del tratamiento y la pérdida de seguimiento en una cohorte con tratamiento antirretroviral en Kenia
Author(s) -
Karcher Heiko,
Omondi Austin,
Odera John,
Kunz Andrea,
Harms Gundel
Publication year - 2007
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2007.01830.x
Subject(s) - medicine , hazard ratio , confidence interval , odds ratio , cohort , cohort study , incidence (geometry) , logistic regression , proportional hazards model , pregnancy , demography , physics , sociology , biology , optics , genetics
Summary Objectives: To evaluate risk factors for treatment denial and loss to follow‐up in an antiretroviral treatment (ART) cohort in a rural African setting in western Kenya. Method: Sociodemographic and clinical data of patients enrolled in an ART cohort were collected within 18 months of an observational longitudinal study and analysed by logistic and Cox regression models. Results: Of 159 patients with treatment indication 35 (22%) never started ART. Pregnancy [adjusted odds ratio (AOR) 3.60, 95% confidence interval (CI) 1.10–11.8; P = 0.035] and lower level of education (AOR 3.80, 95% CI 1.14–12.7; P = 0.03) were independently associated with treatment denial. The incidence of total loss of patients under therapy was 43.2 per 100 person years (pys) (mortality rate 19.2 per 100 pys plus drop out rate 24 per 100 pys). Older age [adjusted hazard ratio (AHR) 1.06, 95% CI 1.01–1.12; P = 0.04], AIDS before starting treatment (AHR 5.83, 95% CI 1.15–29.5; P = 0.03) and incomplete adherence to treatment (AHR 1.05, 95% CI 1.03–1.07; P < 0.001) were independent risk factors for death. Incomplete adherence also independently predicted drop out because of other reasons (AHR 1.06, 95% CI 1.04–1.09; P < 0.001). Conclusion: Pregnancy and lower level of education, higher age, advanced AIDS stage and impaired compliance to ART were identified as risk factors for treatment denial and death, respectively. Adequate counselling strategies for patients with these characteristics could help to improve adherence and outcome of treatment programmes in resource‐limited settings.