title: Risk factors for treatment denial and loss to follow-up in an antiretroviral treatment cohort in Kenya.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors: Institute of Tropical Medicine and International Health, Charité-University Medicine Berlin, Germany. heiko.karcher@charite.de
authors: Heiko
authors: H
authors: Karcher
authors: Austin
authors: A
authors: Omondi
authors: John
authors: J
authors: Odera
authors: Andrea
authors: A
authors: Kunz
authors: Gundel
authors: G
authors: Harms
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008134:Long-Term Care / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors
chemical_list: D044966:Anti-Retroviral Agents