title: High rates of unplanned interruptions from HIV care early after antiretroviral therapy initiation in Nigeria.
abstract: BACKGROUND
  Unplanned care interruption (UCI) challenges effective HIV treatment. We determined the frequency and risk factors for UCI in Nigeria.
  
  
  METHODS
  We conducted a retrospective-cohort study of adults initiating antiretroviral therapy (ART) between January 2009 and December 2011. At censor, patients were defined as in care, UCI, or inactive. Associations between baseline factors and UCI rates were quantified using Poisson regression.
  
  
  RESULTS
  Among 2,496 patients, 44 % remained in care, 35 % had ≥1 UCI, and 21 % became inactive. UCI rates were higher in the first year on ART (39/100PY), than the second (19/100PY), third (16/100PY), and fourth (14/100PY) years (p < 0.001). In multivariate analysis, baseline CD4 > 350/uL (IRR 3.21, p < 0.0001), being a student (IRR 1.95, p < 0.0001), and less education (IRR 1.58, p = 0.001) increased risk for UCI. Fifty-five percent of patients with UCI and viral load data had HIV viral load > 1,000 copies/ml upon return to care.
  
  
  CONCLUSIONS
  UCI were observed in over one-third of patients treated, and were most common in the first year on ART. High baseline CD4 count at ART initiation was the greatest predictor of subsequent UCI.
  
  
  CONCLUSIONS
  Interventions focused on the first year on ART are needed to improve continuity of HIV care.
authors.affiliation: Division of Infectious Disease, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, USA. aahonkhai@mgh.harvard.edu.|Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA. aahonkhai@mgh.harvard.edu.
authors.forename: Aimalohi A
authors.initials: AA
authors.lastname: Ahonkhai
authors.affiliation: AIDS Prevention Initiative in Nigeria (APIN), Abuja, Nigeria. baluko@apin.org.ng.
authors.forename: Bolanle
authors.initials: B
authors.lastname: Banigbe
authors.affiliation: AIDS Prevention Initiative in Nigeria (APIN), Abuja, Nigeria. jadeola@apin.org.ng.
authors.forename: Juliet
authors.initials: J
authors.lastname: Adeola
authors.affiliation: AIDS Prevention Initiative in Nigeria (APIN), Abuja, Nigeria. ionwuatuelo@apin.org.ng.
authors.forename: Ifeyinwa
authors.initials: I
authors.lastname: Onwuatuelo
authors.affiliation: Division of Infectious Disease, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, USA. ibassett@mgh.harvard.edu.|Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA. ibassett@mgh.harvard.edu.|Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA. ibassett@mgh.harvard.edu.|Harvard University Center for AIDS Research (CFAR), Boston, MA, USA. ibassett@mgh.harvard.edu.
authors.forename: Ingrid V
authors.initials: IV
authors.lastname: Bassett
authors.affiliation: Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA. elosina@partners.org.|Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA. elosina@partners.org.|Departments of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, MA, USA. elosina@partners.org.
authors.forename: Elena
authors.initials: E
authors.lastname: Losina
authors.affiliation: Division of Infectious Disease, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA, USA. kfreedberg@mgh.harvard.edu.|Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA. kfreedberg@mgh.harvard.edu.|Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA. kfreedberg@mgh.harvard.edu.|Harvard University Center for AIDS Research (CFAR), Boston, MA, USA. kfreedberg@mgh.harvard.edu.|Departments of Biostatistics and Epidemiology, Boston University School of Public Health, Boston, MA, USA. kfreedberg@mgh.harvard.edu.|Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA. kfreedberg@mgh.harvard.edu.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Freedberg
authors.affiliation: AIDS Prevention Initiative in Nigeria (APIN), Abuja, Nigeria. pokonkwo@apin.org.ng.
authors.forename: Prosper
authors.initials: P
authors.lastname: Okonkwo
authors.affiliation: Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA. sregan@mgh.harvard.edu.|Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA. sregan@mgh.harvard.edu.|Harvard University Center for AIDS Research (CFAR), Boston, MA, USA. sregan@mgh.harvard.edu.
authors.forename: Susan
authors.initials: S
authors.lastname: Regan
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000235:genetics; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009549:Nigeria; D012367:RNA, Viral / Q000032:analysis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral