Trends in and determinants of loss to follow up and early mortality in a rapid expansion of the antiretroviral treatment program in Vietnam: findings from 13 outpatient clinics.
BACKGROUND
This study aims to describe the trends in and determinants of six month mortality and loss to follow up (LTFU) during 2005-2009 in 13 outpatient clinics in Vietnam.


METHODS
Data were obtained from clinical records of 3,449 Vietnamese HIV/AIDS patients aged 18 years or older who initiated ART between 1 January 2005 and 31 December 2009. Mantel-Haenszel chi-square test, log rank test were conducted to examine the trends of baseline characteristics, six month mortality and LTFU. Cox proportional hazards regression models were performed to compute hazard ratio (HR) and 95% Confidence Interval (CI).


RESULTS
Though there was a declining trend, the incidence of six month mortality and LTFU remained as high as 6% and 15%, respectively. Characteristics associated with six month mortality were gender (HR females versus males 0.54, 95%CI: 0.34-0.85), years of initiation (HR 2009 versus 2005 0.54, 95%CI: 0.41-0.80), low baseline CD4 (HR 350-500 cells/mm(3) versus <50 cells/mm(3) 0.26, 95%CI: 0.18-0.52), low baseline BMI (one unit increase: HR 0.96, 95%CI: 0.94-0.97), co-infection with TB (HR 1.61, 95%CI: 1.46-1.95), history of injecting drugs (HR 1.58, 95%CI: 1.31-1.78). Characteristics associated with LTFU were younger age (one year younger: HR 0.97, 95%CI: 0.95-0.98), males (HR females versus males 0.82, 95%CI: 0.63-0.95), and poor adherence (HR 0.55, 95%CI: 0.13-0.87).


CONCLUSIONS
To reduce early mortality, special attention is required to ensure timely access to ART services, particularly for patients at higher risk. Patients at risk for LTFU after ART initiation should be targeted through enhancing treatment counselling and improving patient tracing system at ART clinics.
Kirby Institute, The University of New South Wales, Sydney, New South Wales, Australia ; National Drug Alcohol Research Centre, The University of New South Wales, Sydney, New South Wales, Australia.
Dam Anh
DA
Tran
Anh Duc
AD
Ngo
Anthony
A
Shakeshaft
David P
DP
Wilson
Christopher
C
Doran
Lei
L
Zhang
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D011446:Prospective Studies; D014744:Vietnam
D044966:Anti-Retroviral Agents