title: Treatment Discontinuation in Adult HIV-Infected Patients on First-Line Antiretroviral Therapy in Nigeria.
abstract: BACKGROUND
  Retention in care and treatment services is critical to health outcomes of individuals diagnosed and living with HIV. We evaluated the incidence of and risk factors for treatment discontinuation (TD) in a large adult HIV population on ART in Nigeria.
  
  
  METHODS
  A retrospective cohort study of adult HIV patients initiated on first-line ART between 2004 and 2011 at the Jos University Teaching Hospital (JUTH) in Nigeria. Follow up information of participants was retrieved from various sources (patient visit database, pharmacy data and patients charts) up to the end of 2012. The primary study endpoint was TD, defined as discontinuation of ART for any reason, including death or loss to follow-up (lack of pharmacy pick-up for periods≥12 months). The Incidence and hazard for TD were estimated by Kaplan-Meier and Cox proportional regression analysis, respectively.
  
  
  RESULTS
  Overall, 3,362 (28%) patients discontinued treatment during 49,436 person-years (py) of follow-up (incidence rate (IR) 6.8 TD per 100 py). The hazard of treatment discontinuation decreased with increasing age (adjusted hazard ratio (aHR 0.99; 95% CI 0.98-0.99). Other independent risk factors for treatment discontinuation were: being unmarried (aHR 1.24; 95% CI: 1.12-1.38), having primary or secondary level of education as compared to tertiary level education (aHR 1.24; 95% CI: 1.12-1.40) and average percent adherence to drug refill visits<95% (adjusted hazard ratio (aHR) 2.13; 95% CI: 1.9-2.40). Compared to tenofovir, greater hazard of TD was noted in patients initiated on ART containing didanosine (aHR) 1.73; 95% CI: 1.03-2.91), but lower in those initiated on zidovudine containing regimen (aHR 0.77; 95% CI: 0.69-0.86).
  
  
  CONCLUSIONS
  Long-term treatment discontinuation rate in this study was comparable to estimates in resource-rich countries. Younger patients, as well as patients with lower educational levels and those with poor adherence had significant hazards for treatment discontinuation and should be the target of interventions to reduce treatment discontinuation and improve retention, especially within the first year of ART.
authors.forename: O O
authors.initials: OO
authors.lastname: Agbaji
authors.affiliation: Pharmacy Department, Jos University Teaching Hospital, Jos, Nigeria. isaacabah@gmail.com.
authors.forename: I O
authors.initials: IO
authors.lastname: Abah
authors.forename: K D
authors.initials: KD
authors.lastname: Falang
authors.forename: A O
authors.initials: AO
authors.lastname: Ebonyi
authors.forename: J
authors.initials: J
authors.lastname: Musa
authors.forename: P
authors.initials: P
authors.lastname: Ugoagwu
authors.forename: P A
authors.initials: PA
authors.lastname: Agaba
authors.forename: A S
authors.initials: AS
authors.lastname: Sagay
authors.forename: T
authors.initials: T
authors.lastname: Jolayemi
authors.forename: P
authors.initials: P
authors.lastname: Okonkwo
authors.forename: J A
authors.initials: JA
authors.lastname: Idoko
authors.forename: Phyllis J
authors.initials: PJ
authors.lastname: Kanki
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D008297:Male; D055118:Medication Adherence; D009549:Nigeria; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D044966:Anti-Retroviral Agents