Open AccessLong-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study
Author(s) -
Catrina Mugglin,
Andreas D Haas,
Joep J. van Oosterhout,
Malango Msukwa,
Lyson Tenthani,
Janne Estill,
Matthias Egger,
Olivia Keiser
Publication year - 2019
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0224837
Subject(s) - medicine , interquartile range , pediatrics , young adult , antiretroviral therapy , cohort , retention rate , proportional hazards model , attrition , cohort study , prospective cohort study , lost to follow up , demography , human immunodeficiency virus (hiv) , gerontology , viral load , family medicine , surgery , dentistry , computer security , sociology , computer science
Objectives We examine long-term retention of adults, adolescents and children on antiretroviral therapy under different HIV treatment guidelines in Malawi. Design Prospective cohort study. Setting and participants Adults and children starting ART between 2005 and 2015 in 21 health facilities in southern Malawi. Methods We used survival analysis to assess retention at clinic level, Cox regression to examine risk factors for loss to follow up, and competing risk analysis to assess long-term outcomes of people on antiretroviral therapy (ART). Results We included 132,274 individuals in our analysis, totalling 270,256 person years of follow up (PYFU; median per patient 1.3, interquartile range (IQR) 0.26–3.1), 62% were female and the median age was 32 years. Retention on ART was lower in the first year on ART compared to subsequent years for all guideline periods and age groups. Infants (0–3 years), adolescents and young adults (15–24 years) were at highest risk of LTFU. Comparing the different calendar periods of ART initiation we found that retention improved initially, but remained stable thereafter. Conclusion Even though the number of patients and the burden on health care system increased substantially during the study period of rapid ART expansion, retention on ART improved in the early years of ART provision, but gains in retention were not maintained over 5 years on ART. Reducing high attrition in the first year of ART should remain a priority for ART programs, and so should addressing poor retention among adolescents, young adults and men.