title: Demographic characteristics and opportunistic diseases associated with attrition during preparation for antiretroviral therapy in primary health centres in Kibera, Kenya.
abstract: Using routine data from HIV-positive adult patients eligible for antiretroviral therapy (ART), we report on routinely collected demographic characteristics and opportunistic diseases associated with pre-ART attrition (deaths and loss to follow-up). Among 2471 ART eligible patients, enrolled between January 2005 and November 2008, 446 (18%) were lost to attrition pre-ART. Adjusted risk factors significantly associated with pre-ART attrition included age <35 years (Odds Ratio, OR 1.4, 95% Confidence Interval, CI 1.1-1.8), severe malnutrition (OR 1.5, 95% CI 1.1-2.0), active pulmonary tuberculosis (OR 1.6, 95% CI 1.1-2.4), severe bacterial infections including severe bacterial pneumonia (OR 1.9, 95% CI 1.2-2.8) and prolonged unexplained fever (>1 month), (OR 2.6, 95% CI 1.3-5.2). This study highlights a number of clinical markers associated with pre-ART attrition that could serve as 'pointers' or screening tools to identify patients who merit fast-tracking onto ART and/or closer clinical attention and follow-up.
authors.affiliation: Medecins sans Frontieres, Medical Department (Operational Research), Brussels Operational Center, Luxembourg, Luxembourg.
authors.forename: K
authors.initials: K
authors.lastname: Tayler-Smith
authors.forename: R
authors.initials: R
authors.lastname: Zachariah
authors.forename: M
authors.initials: M
authors.lastname: Manzi
authors.forename: W
authors.initials: W
authors.lastname: Kizito
authors.forename: A
authors.initials: A
authors.lastname: Vandenbulcke
authors.forename: S
authors.initials: S
authors.lastname: Dunkley
authors.forename: D
authors.initials: D
authors.lastname: von Rege
authors.forename: T
authors.initials: T
authors.lastname: Reid
authors.forename: L
authors.initials: L
authors.lastname: Arnould
authors.forename: A
authors.initials: A
authors.lastname: Suleh
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D018579:Patient Selection; D018410:Pneumonia, Bacterial / Q000453:epidemiology; D011320:Primary Health Care; D012307:Risk Factors; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents