Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study.

OBJECTIVES:We examine long-term retention of adults, adolescents and children on antiretroviral therapy under different HIV treatment guidelines in Malawi. DESIGN:Prospective cohort study. SETTING AND PARTICIPANTS:Adults and children starting ART between 2005 and 2015 in 21 health facilities in sout...
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Autor*in:	Catrina Mugglin [verfasserIn] Andreas D Haas [verfasserIn] Joep J van Oosterhout [verfasserIn] Malango Msukwa [verfasserIn] Lyson Tenthani [verfasserIn] Janne Estill [verfasserIn] Matthias Egger [verfasserIn] Olivia Keiser [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2019

Übergeordnetes Werk:	In: PLoS ONE - Public Library of Science (PLoS), 2007, 14(2019), 11, p e0224837
Übergeordnetes Werk:	volume:14 ; year:2019 ; number:11, p e0224837

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.1371/journal.pone.0224837

Katalog-ID:	DOAJ077220978

Internformat


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100	0		\|a Catrina Mugglin \|e verfasserin \|4 aut
245	1	0	\|a Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study.
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520			\|a OBJECTIVES:We examine long-term retention of adults, adolescents and children on antiretroviral therapy under different HIV treatment guidelines in Malawi. DESIGN:Prospective cohort study. SETTING AND PARTICIPANTS:Adults and children starting ART between 2005 and 2015 in 21 health facilities in southern Malawi. METHODS:We used survival analysis to assess retention at clinic level, Cox regression to examine risk factors for loss to follow up, and competing risk analysis to assess long-term outcomes of people on antiretroviral therapy (ART). RESULTS:We included 132,274 individuals in our analysis, totalling 270,256 person years of follow up (PYFU; median per patient 1.3, interquartile range (IQR) 0.26-3.1), 62% were female and the median age was 32 years. Retention on ART was lower in the first year on ART compared to subsequent years for all guideline periods and age groups. Infants (0-3 years), adolescents and young adults (15-24 years) were at highest risk of LTFU. Comparing the different calendar periods of ART initiation we found that retention improved initially, but remained stable thereafter. CONCLUSION:Even though the number of patients and the burden on health care system increased substantially during the study period of rapid ART expansion, retention on ART improved in the early years of ART provision, but gains in retention were not maintained over 5 years on ART. Reducing high attrition in the first year of ART should remain a priority for ART programs, and so should addressing poor retention among adolescents, young adults and men.
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700	0		\|a Malango Msukwa \|e verfasserin \|4 aut
700	0		\|a Lyson Tenthani \|e verfasserin \|4 aut
700	0		\|a Janne Estill \|e verfasserin \|4 aut
700	0		\|a Matthias Egger \|e verfasserin \|4 aut
700	0		\|a Olivia Keiser \|e verfasserin \|4 aut
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912			\|a GBV_ILN_4323
912			\|a GBV_ILN_4324
912			\|a GBV_ILN_4325
912			\|a GBV_ILN_4335
912			\|a GBV_ILN_4338
912			\|a GBV_ILN_4367
912			\|a GBV_ILN_4700
951			\|a AR
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Indexfelder

author_variant	c m cm a d h adh j j v o jjvo m m mm l t lt j e je m e me o k ok
matchkey_str	article:19326203:2019----::ogemeetooatrtoiateaymnifnshlrndlsetad
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publishDate	2019
allfields	10.1371/journal.pone.0224837 doi (DE-627)DOAJ077220978 (DE-599)DOAJc7264174da2f4c07813082c25092146c DE-627 ger DE-627 rakwb eng Catrina Mugglin verfasserin aut Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study. 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier OBJECTIVES:We examine long-term retention of adults, adolescents and children on antiretroviral therapy under different HIV treatment guidelines in Malawi. DESIGN:Prospective cohort study. SETTING AND PARTICIPANTS:Adults and children starting ART between 2005 and 2015 in 21 health facilities in southern Malawi. METHODS:We used survival analysis to assess retention at clinic level, Cox regression to examine risk factors for loss to follow up, and competing risk analysis to assess long-term outcomes of people on antiretroviral therapy (ART). RESULTS:We included 132,274 individuals in our analysis, totalling 270,256 person years of follow up (PYFU; median per patient 1.3, interquartile range (IQR) 0.26-3.1), 62% were female and the median age was 32 years. Retention on ART was lower in the first year on ART compared to subsequent years for all guideline periods and age groups. Infants (0-3 years), adolescents and young adults (15-24 years) were at highest risk of LTFU. Comparing the different calendar periods of ART initiation we found that retention improved initially, but remained stable thereafter. CONCLUSION:Even though the number of patients and the burden on health care system increased substantially during the study period of rapid ART expansion, retention on ART improved in the early years of ART provision, but gains in retention were not maintained over 5 years on ART. Reducing high attrition in the first year of ART should remain a priority for ART programs, and so should addressing poor retention among adolescents, young adults and men. Medicine R Science Q Andreas D Haas verfasserin aut Joep J van Oosterhout verfasserin aut Malango Msukwa verfasserin aut Lyson Tenthani verfasserin aut Janne Estill verfasserin aut Matthias Egger verfasserin aut Olivia Keiser verfasserin aut In PLoS ONE Public Library of Science (PLoS), 2007 14(2019), 11, p e0224837 (DE-627)523574592 (DE-600)2267670-3 19326203 nnns volume:14 year:2019 number:11, p e0224837 https://doi.org/10.1371/journal.pone.0224837 kostenfrei https://doaj.org/article/c7264174da2f4c07813082c25092146c kostenfrei https://doi.org/10.1371/journal.pone.0224837 kostenfrei https://doaj.org/toc/1932-6203 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_34 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_235 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_2522 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 14 2019 11, p e0224837
spelling	10.1371/journal.pone.0224837 doi (DE-627)DOAJ077220978 (DE-599)DOAJc7264174da2f4c07813082c25092146c DE-627 ger DE-627 rakwb eng Catrina Mugglin verfasserin aut Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study. 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier OBJECTIVES:We examine long-term retention of adults, adolescents and children on antiretroviral therapy under different HIV treatment guidelines in Malawi. DESIGN:Prospective cohort study. SETTING AND PARTICIPANTS:Adults and children starting ART between 2005 and 2015 in 21 health facilities in southern Malawi. METHODS:We used survival analysis to assess retention at clinic level, Cox regression to examine risk factors for loss to follow up, and competing risk analysis to assess long-term outcomes of people on antiretroviral therapy (ART). RESULTS:We included 132,274 individuals in our analysis, totalling 270,256 person years of follow up (PYFU; median per patient 1.3, interquartile range (IQR) 0.26-3.1), 62% were female and the median age was 32 years. Retention on ART was lower in the first year on ART compared to subsequent years for all guideline periods and age groups. Infants (0-3 years), adolescents and young adults (15-24 years) were at highest risk of LTFU. Comparing the different calendar periods of ART initiation we found that retention improved initially, but remained stable thereafter. CONCLUSION:Even though the number of patients and the burden on health care system increased substantially during the study period of rapid ART expansion, retention on ART improved in the early years of ART provision, but gains in retention were not maintained over 5 years on ART. Reducing high attrition in the first year of ART should remain a priority for ART programs, and so should addressing poor retention among adolescents, young adults and men. Medicine R Science Q Andreas D Haas verfasserin aut Joep J van Oosterhout verfasserin aut Malango Msukwa verfasserin aut Lyson Tenthani verfasserin aut Janne Estill verfasserin aut Matthias Egger verfasserin aut Olivia Keiser verfasserin aut In PLoS ONE Public Library of Science (PLoS), 2007 14(2019), 11, p e0224837 (DE-627)523574592 (DE-600)2267670-3 19326203 nnns volume:14 year:2019 number:11, p e0224837 https://doi.org/10.1371/journal.pone.0224837 kostenfrei https://doaj.org/article/c7264174da2f4c07813082c25092146c kostenfrei https://doi.org/10.1371/journal.pone.0224837 kostenfrei https://doaj.org/toc/1932-6203 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_34 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_235 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_2522 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 14 2019 11, p e0224837
allfields_unstemmed	10.1371/journal.pone.0224837 doi (DE-627)DOAJ077220978 (DE-599)DOAJc7264174da2f4c07813082c25092146c DE-627 ger DE-627 rakwb eng Catrina Mugglin verfasserin aut Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study. 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier OBJECTIVES:We examine long-term retention of adults, adolescents and children on antiretroviral therapy under different HIV treatment guidelines in Malawi. DESIGN:Prospective cohort study. SETTING AND PARTICIPANTS:Adults and children starting ART between 2005 and 2015 in 21 health facilities in southern Malawi. METHODS:We used survival analysis to assess retention at clinic level, Cox regression to examine risk factors for loss to follow up, and competing risk analysis to assess long-term outcomes of people on antiretroviral therapy (ART). RESULTS:We included 132,274 individuals in our analysis, totalling 270,256 person years of follow up (PYFU; median per patient 1.3, interquartile range (IQR) 0.26-3.1), 62% were female and the median age was 32 years. Retention on ART was lower in the first year on ART compared to subsequent years for all guideline periods and age groups. Infants (0-3 years), adolescents and young adults (15-24 years) were at highest risk of LTFU. Comparing the different calendar periods of ART initiation we found that retention improved initially, but remained stable thereafter. CONCLUSION:Even though the number of patients and the burden on health care system increased substantially during the study period of rapid ART expansion, retention on ART improved in the early years of ART provision, but gains in retention were not maintained over 5 years on ART. Reducing high attrition in the first year of ART should remain a priority for ART programs, and so should addressing poor retention among adolescents, young adults and men. Medicine R Science Q Andreas D Haas verfasserin aut Joep J van Oosterhout verfasserin aut Malango Msukwa verfasserin aut Lyson Tenthani verfasserin aut Janne Estill verfasserin aut Matthias Egger verfasserin aut Olivia Keiser verfasserin aut In PLoS ONE Public Library of Science (PLoS), 2007 14(2019), 11, p e0224837 (DE-627)523574592 (DE-600)2267670-3 19326203 nnns volume:14 year:2019 number:11, p e0224837 https://doi.org/10.1371/journal.pone.0224837 kostenfrei https://doaj.org/article/c7264174da2f4c07813082c25092146c kostenfrei https://doi.org/10.1371/journal.pone.0224837 kostenfrei https://doaj.org/toc/1932-6203 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_34 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_235 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_2522 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 14 2019 11, p e0224837
allfieldsGer	10.1371/journal.pone.0224837 doi (DE-627)DOAJ077220978 (DE-599)DOAJc7264174da2f4c07813082c25092146c DE-627 ger DE-627 rakwb eng Catrina Mugglin verfasserin aut Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study. 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier OBJECTIVES:We examine long-term retention of adults, adolescents and children on antiretroviral therapy under different HIV treatment guidelines in Malawi. DESIGN:Prospective cohort study. SETTING AND PARTICIPANTS:Adults and children starting ART between 2005 and 2015 in 21 health facilities in southern Malawi. METHODS:We used survival analysis to assess retention at clinic level, Cox regression to examine risk factors for loss to follow up, and competing risk analysis to assess long-term outcomes of people on antiretroviral therapy (ART). RESULTS:We included 132,274 individuals in our analysis, totalling 270,256 person years of follow up (PYFU; median per patient 1.3, interquartile range (IQR) 0.26-3.1), 62% were female and the median age was 32 years. Retention on ART was lower in the first year on ART compared to subsequent years for all guideline periods and age groups. Infants (0-3 years), adolescents and young adults (15-24 years) were at highest risk of LTFU. Comparing the different calendar periods of ART initiation we found that retention improved initially, but remained stable thereafter. CONCLUSION:Even though the number of patients and the burden on health care system increased substantially during the study period of rapid ART expansion, retention on ART improved in the early years of ART provision, but gains in retention were not maintained over 5 years on ART. Reducing high attrition in the first year of ART should remain a priority for ART programs, and so should addressing poor retention among adolescents, young adults and men. Medicine R Science Q Andreas D Haas verfasserin aut Joep J van Oosterhout verfasserin aut Malango Msukwa verfasserin aut Lyson Tenthani verfasserin aut Janne Estill verfasserin aut Matthias Egger verfasserin aut Olivia Keiser verfasserin aut In PLoS ONE Public Library of Science (PLoS), 2007 14(2019), 11, p e0224837 (DE-627)523574592 (DE-600)2267670-3 19326203 nnns volume:14 year:2019 number:11, p e0224837 https://doi.org/10.1371/journal.pone.0224837 kostenfrei https://doaj.org/article/c7264174da2f4c07813082c25092146c kostenfrei https://doi.org/10.1371/journal.pone.0224837 kostenfrei https://doaj.org/toc/1932-6203 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_34 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_235 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_2522 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 14 2019 11, p e0224837
allfieldsSound	10.1371/journal.pone.0224837 doi (DE-627)DOAJ077220978 (DE-599)DOAJc7264174da2f4c07813082c25092146c DE-627 ger DE-627 rakwb eng Catrina Mugglin verfasserin aut Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study. 2019 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier OBJECTIVES:We examine long-term retention of adults, adolescents and children on antiretroviral therapy under different HIV treatment guidelines in Malawi. DESIGN:Prospective cohort study. SETTING AND PARTICIPANTS:Adults and children starting ART between 2005 and 2015 in 21 health facilities in southern Malawi. METHODS:We used survival analysis to assess retention at clinic level, Cox regression to examine risk factors for loss to follow up, and competing risk analysis to assess long-term outcomes of people on antiretroviral therapy (ART). RESULTS:We included 132,274 individuals in our analysis, totalling 270,256 person years of follow up (PYFU; median per patient 1.3, interquartile range (IQR) 0.26-3.1), 62% were female and the median age was 32 years. Retention on ART was lower in the first year on ART compared to subsequent years for all guideline periods and age groups. Infants (0-3 years), adolescents and young adults (15-24 years) were at highest risk of LTFU. Comparing the different calendar periods of ART initiation we found that retention improved initially, but remained stable thereafter. CONCLUSION:Even though the number of patients and the burden on health care system increased substantially during the study period of rapid ART expansion, retention on ART improved in the early years of ART provision, but gains in retention were not maintained over 5 years on ART. Reducing high attrition in the first year of ART should remain a priority for ART programs, and so should addressing poor retention among adolescents, young adults and men. Medicine R Science Q Andreas D Haas verfasserin aut Joep J van Oosterhout verfasserin aut Malango Msukwa verfasserin aut Lyson Tenthani verfasserin aut Janne Estill verfasserin aut Matthias Egger verfasserin aut Olivia Keiser verfasserin aut In PLoS ONE Public Library of Science (PLoS), 2007 14(2019), 11, p e0224837 (DE-627)523574592 (DE-600)2267670-3 19326203 nnns volume:14 year:2019 number:11, p e0224837 https://doi.org/10.1371/journal.pone.0224837 kostenfrei https://doaj.org/article/c7264174da2f4c07813082c25092146c kostenfrei https://doi.org/10.1371/journal.pone.0224837 kostenfrei https://doaj.org/toc/1932-6203 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ SSG-OLC-PHA GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_34 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_235 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_702 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2031 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2057 GBV_ILN_2061 GBV_ILN_2111 GBV_ILN_2113 GBV_ILN_2190 GBV_ILN_2522 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 14 2019 11, p e0224837
language	English
source	In PLoS ONE 14(2019), 11, p e0224837 volume:14 year:2019 number:11, p e0224837
sourceStr	In PLoS ONE 14(2019), 11, p e0224837 volume:14 year:2019 number:11, p e0224837
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authorswithroles_txt_mv	Catrina Mugglin @@aut@@ Andreas D Haas @@aut@@ Joep J van Oosterhout @@aut@@ Malango Msukwa @@aut@@ Lyson Tenthani @@aut@@ Janne Estill @@aut@@ Matthias Egger @@aut@@ Olivia Keiser @@aut@@
publishDateDaySort_date	2019-01-01T00:00:00Z
hierarchy_top_id	523574592
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author	Catrina Mugglin
spellingShingle	Catrina Mugglin misc Medicine misc R misc Science misc Q Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study.
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topic_title	Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study
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title	Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study.
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title_full	Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study
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author_browse	Catrina Mugglin Andreas D Haas Joep J van Oosterhout Malango Msukwa Lyson Tenthani Janne Estill Matthias Egger Olivia Keiser
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title_sort	long-term retention on antiretroviral therapy among infants, children, adolescents and adults in malawi: a cohort study
title_auth	Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study.
abstract	OBJECTIVES:We examine long-term retention of adults, adolescents and children on antiretroviral therapy under different HIV treatment guidelines in Malawi. DESIGN:Prospective cohort study. SETTING AND PARTICIPANTS:Adults and children starting ART between 2005 and 2015 in 21 health facilities in southern Malawi. METHODS:We used survival analysis to assess retention at clinic level, Cox regression to examine risk factors for loss to follow up, and competing risk analysis to assess long-term outcomes of people on antiretroviral therapy (ART). RESULTS:We included 132,274 individuals in our analysis, totalling 270,256 person years of follow up (PYFU; median per patient 1.3, interquartile range (IQR) 0.26-3.1), 62% were female and the median age was 32 years. Retention on ART was lower in the first year on ART compared to subsequent years for all guideline periods and age groups. Infants (0-3 years), adolescents and young adults (15-24 years) were at highest risk of LTFU. Comparing the different calendar periods of ART initiation we found that retention improved initially, but remained stable thereafter. CONCLUSION:Even though the number of patients and the burden on health care system increased substantially during the study period of rapid ART expansion, retention on ART improved in the early years of ART provision, but gains in retention were not maintained over 5 years on ART. Reducing high attrition in the first year of ART should remain a priority for ART programs, and so should addressing poor retention among adolescents, young adults and men.
abstractGer	OBJECTIVES:We examine long-term retention of adults, adolescents and children on antiretroviral therapy under different HIV treatment guidelines in Malawi. DESIGN:Prospective cohort study. SETTING AND PARTICIPANTS:Adults and children starting ART between 2005 and 2015 in 21 health facilities in southern Malawi. METHODS:We used survival analysis to assess retention at clinic level, Cox regression to examine risk factors for loss to follow up, and competing risk analysis to assess long-term outcomes of people on antiretroviral therapy (ART). RESULTS:We included 132,274 individuals in our analysis, totalling 270,256 person years of follow up (PYFU; median per patient 1.3, interquartile range (IQR) 0.26-3.1), 62% were female and the median age was 32 years. Retention on ART was lower in the first year on ART compared to subsequent years for all guideline periods and age groups. Infants (0-3 years), adolescents and young adults (15-24 years) were at highest risk of LTFU. Comparing the different calendar periods of ART initiation we found that retention improved initially, but remained stable thereafter. CONCLUSION:Even though the number of patients and the burden on health care system increased substantially during the study period of rapid ART expansion, retention on ART improved in the early years of ART provision, but gains in retention were not maintained over 5 years on ART. Reducing high attrition in the first year of ART should remain a priority for ART programs, and so should addressing poor retention among adolescents, young adults and men.
abstract_unstemmed	OBJECTIVES:We examine long-term retention of adults, adolescents and children on antiretroviral therapy under different HIV treatment guidelines in Malawi. DESIGN:Prospective cohort study. SETTING AND PARTICIPANTS:Adults and children starting ART between 2005 and 2015 in 21 health facilities in southern Malawi. METHODS:We used survival analysis to assess retention at clinic level, Cox regression to examine risk factors for loss to follow up, and competing risk analysis to assess long-term outcomes of people on antiretroviral therapy (ART). RESULTS:We included 132,274 individuals in our analysis, totalling 270,256 person years of follow up (PYFU; median per patient 1.3, interquartile range (IQR) 0.26-3.1), 62% were female and the median age was 32 years. Retention on ART was lower in the first year on ART compared to subsequent years for all guideline periods and age groups. Infants (0-3 years), adolescents and young adults (15-24 years) were at highest risk of LTFU. Comparing the different calendar periods of ART initiation we found that retention improved initially, but remained stable thereafter. CONCLUSION:Even though the number of patients and the burden on health care system increased substantially during the study period of rapid ART expansion, retention on ART improved in the early years of ART provision, but gains in retention were not maintained over 5 years on ART. Reducing high attrition in the first year of ART should remain a priority for ART programs, and so should addressing poor retention among adolescents, young adults and men.
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title_short	Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study.
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Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study.

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