Risk factors for unstructured treatment interruptions and association with survival in low to middle income countries

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dc.contributor.authorMcMahon, James H
dc.contributor.authorSpelman, Tim
dc.contributor.authorFord, Nathan
dc.contributor.authorGreig, Jane
dc.contributor.authorMesic, Anita
dc.contributor.authorSsonko, Charles
dc.contributor.authorCasas, Esther C
dc.contributor.authorO’Brien, Daniel P
dc.date.accessioned2021-10-08T11:00:53Z
dc.date.available2021-10-08T11:00:53Z
dc.date.issued2016
dc.description.abstractAbstract Background Antiretroviral therapy (ART) treatment interruptions lead to poor clinical outcomes with unplanned or unstructured TIs (uTIs) likely to be underreported. This study describes; uTIs, their risk factors and association with survival. Methods Analysis of ART programmatic data from 11 countries across Asia and Africa between 2003 and 2013 where an uTI was defined as a ≥90-day patient initiated break from ART calculated from the last day the previous ART prescription would have run out until the date of the next ART prescription. Factors predicting uTI were assessed with a conditional risk-set multiple failure time-to-event model to account for repeated events per subject. Association between uTI and mortality was assessed using Cox proportional hazards, with a competing risks extension to test for the influence of lost to follow-up (LTFU). Results 40,632 patients were included from 11 countries across 33 sites (17 Africa, 16 Asia). Median duration of follow-up was 1.61 years (IQR 0.54–3.31 years), 3386 (8.3 %) patients died, and 3453 (8.5 %) were LTFU. There were 14,817 uTIs, with 10,162 (25 %) patients having more than one uTI. In the adjusted model males were at lower risk of uTI (aHR 0.94, p < 0.01, and age 20–59 was protective compared to <20 years (20–39 years aHR 0.87, p < 0.01; 40–59 years aHR 0.86, p < 0.01). Preserved immune function, as measured by higher CD4 cell count, was associated with a reduced rate of uTI compared to CD4 <200 cells/μL (CD4 200–350 cells/μL aHR 0.89, p < 0.01; CD4 >350 cells/μL aHR 0.87, p < 0.01), whereas advanced clinical disease was associated with increased uTI rate (WHO stage 3 aHR 1.10, p < 0.01; WHO stage 4 aHR 1.21, p < 0.01). There was no relationship between uTI and mortality after adjusting for disease status and considering LTFU as a competing risk. Conclusions uTIs were frequent in people in ART programs in low-middle income countries and associated with younger age, female gender and advanced HIV. uTI did not predict survival when loss to follow-up was considered a competing risk. Further evaluation of uTI predictors and interventions to reduce their occurrence is warranted.
dc.identifier.apacitationMcMahon, J. H., Spelman, T., Ford, N., Greig, J., Mesic, A., Ssonko, C., ... (2016). Risk factors for unstructured treatment interruptions and association with survival in low to middle income countries. <i>AIDS Research and Therapy</i>, 13(1), 174 - 177. http://hdl.handle.net/11427/35041en_ZA
dc.identifier.chicagocitationMcMahon, James H, Tim Spelman, Nathan Ford, Jane Greig, Anita Mesic, Charles Ssonko, Esther C Casas, and "Risk factors for unstructured treatment interruptions and association with survival in low to middle income countries." <i>AIDS Research and Therapy</i> 13, 1. (2016): 174 - 177. http://hdl.handle.net/11427/35041en_ZA
dc.identifier.citationMcMahon, J.H., Spelman, T., Ford, N., Greig, J., Mesic, A., Ssonko, C., Casas, E.C. & et al. 2016. Risk factors for unstructured treatment interruptions and association with survival in low to middle income countries. <i>AIDS Research and Therapy.</i> 13(1):174 - 177. http://hdl.handle.net/11427/35041en_ZA
dc.identifier.issn1742-6405
dc.identifier.ris TY - Journal Article AU - McMahon, James H AU - Spelman, Tim AU - Ford, Nathan AU - Greig, Jane AU - Mesic, Anita AU - Ssonko, Charles AU - Casas, Esther C AU - O’Brien, Daniel P AB - Abstract Background Antiretroviral therapy (ART) treatment interruptions lead to poor clinical outcomes with unplanned or unstructured TIs (uTIs) likely to be underreported. This study describes; uTIs, their risk factors and association with survival. Methods Analysis of ART programmatic data from 11 countries across Asia and Africa between 2003 and 2013 where an uTI was defined as a ≥90-day patient initiated break from ART calculated from the last day the previous ART prescription would have run out until the date of the next ART prescription. Factors predicting uTI were assessed with a conditional risk-set multiple failure time-to-event model to account for repeated events per subject. Association between uTI and mortality was assessed using Cox proportional hazards, with a competing risks extension to test for the influence of lost to follow-up (LTFU). Results 40,632 patients were included from 11 countries across 33 sites (17 Africa, 16 Asia). Median duration of follow-up was 1.61 years (IQR 0.54–3.31 years), 3386 (8.3 %) patients died, and 3453 (8.5 %) were LTFU. There were 14,817 uTIs, with 10,162 (25 %) patients having more than one uTI. In the adjusted model males were at lower risk of uTI (aHR 0.94, p < 0.01, and age 20–59 was protective compared to <20 years (20–39 years aHR 0.87, p < 0.01; 40–59 years aHR 0.86, p < 0.01). Preserved immune function, as measured by higher CD4 cell count, was associated with a reduced rate of uTI compared to CD4 <200 cells/μL (CD4 200–350 cells/μL aHR 0.89, p < 0.01; CD4 >350 cells/μL aHR 0.87, p < 0.01), whereas advanced clinical disease was associated with increased uTI rate (WHO stage 3 aHR 1.10, p < 0.01; WHO stage 4 aHR 1.21, p < 0.01). There was no relationship between uTI and mortality after adjusting for disease status and considering LTFU as a competing risk. Conclusions uTIs were frequent in people in ART programs in low-middle income countries and associated with younger age, female gender and advanced HIV. uTI did not predict survival when loss to follow-up was considered a competing risk. Further evaluation of uTI predictors and interventions to reduce their occurrence is warranted. DA - 2016 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - AIDS Research and Therapy LK - https://open.uct.ac.za PY - 2016 SM - 1742-6405 T1 - Risk factors for unstructured treatment interruptions and association with survival in low to middle income countries TI - Risk factors for unstructured treatment interruptions and association with survival in low to middle income countries UR - http://hdl.handle.net/11427/35041 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/35041
dc.identifier.vancouvercitationMcMahon JH, Spelman T, Ford N, Greig J, Mesic A, Ssonko C, et al. Risk factors for unstructured treatment interruptions and association with survival in low to middle income countries. AIDS Research and Therapy. 2016;13(1):174 - 177. http://hdl.handle.net/11427/35041.en_ZA
dc.language.isoeng
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.sourceAIDS Research and Therapy
dc.source.journalissue1
dc.source.journalvolume13
dc.source.pagination174 - 177
dc.source.urihttps://dx.doi.org/10.1186/s12981-016-0109-8
dc.subject.otherAntiretroviral therapy
dc.subject.otherClinical outcomes
dc.subject.otherEpidemiology
dc.subject.otherResource limited settings
dc.subject.otherSurvival
dc.subject.otherUnstructured treatment interruption
dc.subject.otherAdult
dc.subject.otherAfrica
dc.subject.otherAge Factors
dc.subject.otherAnti-HIV Agents
dc.subject.otherAsia
dc.subject.otherCD4 Lymphocyte Count
dc.subject.otherDeveloping Countries
dc.subject.otherFemale
dc.subject.otherHIV Infections
dc.subject.otherHumans
dc.subject.otherMale
dc.subject.otherMedication Adherence
dc.subject.otherMiddle Aged
dc.subject.otherProportional Hazards Models
dc.subject.otherRisk Factors
dc.subject.otherSex Factors
dc.subject.otherTime Factors
dc.subject.otherYoung Adult
dc.subject.otherAnti-HIV Agents
dc.titleRisk factors for unstructured treatment interruptions and association with survival in low to middle income countries
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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