title: Low retention of HIV-infected patients on antiretroviral therapy in 11 clinical centres in West Africa.
abstract: OBJECTIVE
  To study factors associated with the probability of retention in antiretroviral therapy (ART) programmes in West Africa.
  
  
  METHODS
  The International epidemiologic Databases to Evaluate AIDS (IeDEA) in West Africa is a prospective, operational, observational cohort study based on collaboration between 11 cohorts of HIV-infected adult patients in Benin, Côte d'Ivoire, Gambia, Mali and Senegal. All patients aged 16 and older at ART initiation, with documented gender and date of ART initiation, were included. For those with at least 1 day of follow-up, Kaplan-Meier method and Weibull regression model were used to estimate the 12-month probability of retention in care and the associated factors.
  
  
  RESULTS
  In this data merger, 14 352 patients (61% female) on ART were included. Median age was 37 (interquartile range (IQR): 31-44 years) and median CD4 count at baseline was 131 cells/mm(3) (IQR: 48-221 cells/mm(3)). The first-line regimen was NNRTI-based for 78% of patients, protease inhibitor-based for 17%, and three NRTIs for 3%. The probability of retention was 0.90 [95% confidence interval (CI): 0.89-0.90] at 3 months, 0.84 (95% CI: 0.83-0.85) at 6 months and 0.76 (95% CI: 0.75-0.77) at 12 months. The probability of retention in care was lower in patients with baseline CD4 count <50 cells/mm(3) [adjusted hazard ratio (aHR) = 1.37; 95% CI: 1.27-1.49; P < 0.0001] (reference CD4 > 200 cells/mm(3), in men (aHR = 1.17; 95% CI: 1.10-1.24; P = 0.0002), in younger patients (<30 years) (aHR = 1.10; 95% CI: 1.03-1.19; P = 0.01) and in patients with low haemoglobinaemia <8 g/dl (aHR = 1.33; 95% CI: 1.21-1.45; P < 0.0001). Availability of funds for systematic tracing was associated with better retention (aHR = 0.29; 95% CI: 0.16-0.55; P = 0.001).
  
  
  CONCLUSIONS
  Close follow-up, promoting early access to care and ART and a decentralized system of care may improve the retention in care of HIV-infected patients on ART.
authors.affiliation: INSERM, U897, and ISPED, Université Bordeaux 2, Bordeaux, France. ekouevi@aviso.ci
authors.forename: Didier K
authors.initials: DK
authors.lastname: Ekouevi
authors.forename: Eric
authors.initials: E
authors.lastname: Balestre
authors.forename: Franck-Olivier
authors.initials: FO
authors.lastname: Ba-Gomis
authors.forename: Serge Paul
authors.initials: SP
authors.lastname: Eholie
authors.forename: Moussa
authors.initials: M
authors.lastname: Maiga
authors.forename: Clarisse
authors.initials: C
authors.lastname: Amani-Bosse
authors.forename: Albert
authors.initials: A
authors.lastname: Minga
authors.forename: Eugène
authors.initials: E
authors.lastname: Messou
authors.forename: Papa Salif
authors.initials: PS
authors.lastname: Sow
authors.forename: Charlotte
authors.initials: C
authors.lastname: Lewden
authors.forename: Hamar Allassane
authors.initials: HA
authors.lastname: Traoré
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bissagnene
authors.forename: François
authors.initials: F
authors.lastname: Dabis
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D018791:CD4 Lymphocyte Count; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D055815:Young Adult; D016903:Drug Monitoring