title: Predictors of attrition and immunological failure in HIV-1 patients on highly active antiretroviral therapy from different healthcare settings in Mozambique.
abstract: In Mozambique, the evaluation of retention in HIV care and ART programmes is limited. To assess rate and predictors of attrition (no retention in care) and HAART effectiveness in HIV-1 infected patients who pay for medication and laboratory testing in Mozambique, we conducted a multicenter survey of HIV-1-infected patients who started HAART during 2002-2006. Cox proportional hazard models were used to assess risk of attrition and of therapy failure. Overall, 142 patients from 16 healthcare centers located in the capital city Maputo were followed-up for 22.2 months (12.1-46.7). The retention rate was 75%, 48% and 37% after one, two and three years, respectively. Risk of attrition was lower in patients with higher baseline CD4 count (P = 0.022) and attending healthcare center 1 (HCC1) (P = 0.013). The proportion of individuals with CD4 count ≤ 200 cells/µL was 55% (78/142) at baseline and decreased to 6% (3/52) at 36 months. Among the patients with available VL, 86% (64/74) achieved undetectable VL levels. The rate of immunologic failure was 17.2% (95% CI: 12.6-22.9) per 100 person-years. Risk of failure was associated to higher baseline CD4 count (P = 0.002), likely reflecting low adherence levels, and decreased with baseline VL ≥ 10,000 copies/mL (P = 0.033). These results suggest that HAART can be effective in HIV-1 infected patients from Mozambique that pay for their medication and laboratory testing. Further studies are required to identify the causes for low retention rates in patients with low CD4 counts and to better understand the association between healthcare setting and attrition rate.
authors.affiliation: Centro de Patogénese Molecular, Unidade dos Retrovírus e Infecções Associadas, Faculdade de Farmácia, Universidade de Lisboa, Lisbon, Portugal ; Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario "Gregorio Marañón", Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.
authors.forename: Claudia
authors.initials: C
authors.lastname: Palladino
authors.affiliation: Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario "Gregorio Marañón", Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.
authors.forename: Verónica
authors.initials: V
authors.lastname: Briz
authors.affiliation: Unidad de Investigación, Fundación para la Investigación Biomédica, Hospital General Universitario "Gregorio Marañón", Madrid, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Bellón
authors.affiliation: Centro de Patogénese Molecular, Unidade dos Retrovírus e Infecções Associadas, Faculdade de Farmácia, Universidade de Lisboa, Lisbon, Portugal ; Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz, Caparica, Portugal.
authors.forename: Inês
authors.initials: I
authors.lastname: Bártolo
authors.affiliation: Laboratório de Biologia Molecular, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Carvalho
authors.affiliation: Laboratório de Biologia Molecular, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Camacho
authors.affiliation: Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario "Gregorio Marañón", Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.
authors.forename: M Ángeles
authors.initials: MÁ
authors.lastname: Muñoz-Fernández
authors.affiliation: Serviço de Dermatologia e Venereologia, Hospital de Dia, Hospital Central de Maputo, Maputo, Mozambique.
authors.forename: Rui
authors.initials: R
authors.lastname: Bastos
authors.affiliation: Serviço de Dermatologia e Venereologia, Hospital de Dia, Hospital Central de Maputo, Maputo, Mozambique.
authors.forename: Rolanda
authors.initials: R
authors.lastname: Manuel
authors.affiliation: Unidade de Imunodiagnóstico Viral, Departamento Académico de Microbiologia, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique.
authors.forename: José
authors.initials: J
authors.lastname: Casanovas
authors.affiliation: Centro de Patogénese Molecular, Unidade dos Retrovírus e Infecções Associadas, Faculdade de Farmácia, Universidade de Lisboa, Lisbon, Portugal ; Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz, Caparica, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Taveira
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003695:Delivery of Health Care; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology* / Q000821:virology; D015497:HIV-1 / Q000276:immunology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009073:Mozambique; D019562:Viral Load / Q000276:immunology