title: Retention in care among HIV-positive patients initiating second-line antiretroviral therapy: a retrospective study from an Ethiopian public hospital clinic.
abstract: BACKGROUND
  Access to second-line antiretroviral therapy (ART) for HIV-positive patients remains limited in sub-Saharan Africa. Furthermore, outcomes of second-line ART may be compromised by mortality and loss to follow-up (LTFU).
  
  
  OBJECTIVE
  To determine retention in care among patients receiving second-line ART in a public hospital in Ethiopia, and to investigate factors associated with LTFU among adults and adolescents.
  
  
  METHODS
  HIV-positive persons with documented change of first-line ART to a second-line regimen were retrospectively identified from hospital registers, and data were collected at the time of treatment change and subsequent clinic visits. Baseline variables for adults and adolescents were analyzed using multivariate Cox proportional hazards models comparing subjects remaining in care and those LTFU (defined as a missed appointment of ≥90 days).
  
  
  RESULTS
  A total of 383 persons had started second-line ART (330 adults/adolescents; 53 children) and were followed for a median of 22.2 months (the total follow-up time was 906 person years). At the end of study follow-up, 80.5% of patients remained in care (adults and adolescents 79.8%; children 85.7%). In multivariate analysis, LTFU among adults and adolescents was associated with a baseline CD4 cell count <100 cells/mm(3) and a first-line regimen failure that was not confirmed by HIV RNA testing.
  
  
  CONCLUSIONS
  Although retention in care during second-line ART in this cohort was satisfactory, and similar to that reported from first-line ART programs in Ethiopia, our findings suggest the benefit of earlier recognition of patients with first-line ART failure and confirmation of suspected treatment failure by viral load testing.
authors.affiliation: Section for Infectious Diseases, Institution of Clinical Sciences, Lund University, Malmö, Sweden.
authors.forename: Sten
authors.initials: S
authors.lastname: Wilhelmson
authors.affiliation: Section for Infectious Diseases, Institution of Clinical Sciences, Lund University, Malmö, Sweden.
authors.forename: Anton
authors.initials: A
authors.lastname: Reepalu
authors.affiliation: Section for Infectious Diseases, Institution of Clinical Sciences, Lund University, Malmö, Sweden.|Ministry of Health of Ethiopia, Addis Abeba, Ethiopia.
authors.forename: Taye Tolera
authors.initials: TT
authors.lastname: Balcha
authors.affiliation: Adama Regional Hospital, Adama, Ethiopia.
authors.forename: Godana
authors.initials: G
authors.lastname: Jarso
authors.affiliation: Section for Infectious Diseases, Institution of Clinical Sciences, Lund University, Malmö, Sweden; per.bjorkman@med.lu.se.
authors.forename: Per
authors.initials: P
authors.lastname: Björkman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005002:Ethiopia; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006779:Hospitals, Public; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: Ethiopia; HIV; antiretroviral therapy; loss to follow-up; retention in care; second-line; sub-Saharan Africa