Risk factors for treatment denial and loss to follow‐up in an antiretroviral treatment cohort in Kenya

• Published in: Tropical medicine & international health 2007-05, Vol.12 (5), p.687-694
• Main Authors: Karcher, Heiko, Omondi, Austin, Odera, John, Kunz, Andrea, Harms, Gundel
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Acquired Immunodeficiency Syndrome - drug therapy; Acquired Immunodeficiency Syndrome - epidemiology; Acquired Immunodeficiency Syndrome - psychology; adherence; adherencia; adhérence; Adolescent; Adult; Age Distribution; AIDS; Anti-Retroviral Agents - therapeutic use; Antiretroviral drugs; antiretroviral treatment; Biological and medical sciences; Cohort Studies; Female; General aspects; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - psychology; Humans; Kenya - epidemiology; Long-Term Care - psychology; loss to follow‐up; Male; Medical sciences; Medical treatment; Middle Aged; Patient Compliance - psychology; perte au suivi; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Pregnancy Complications, Infectious - epidemiology; Pregnancy Complications, Infectious - psychology; pérdida de seguimiento; refus de traitement; Regression analysis; rehusar tratamiento; resource‐limited setting; Risk Factors; Rural areas; régions à ressources limitées; Sex Distribution; Socioeconomic Factors; traitement antirétroviral; tratamieto antiretroviral; treatment denial; áreas con recursos limitados
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/j.1365-3156.2007.01830.x

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