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Failure to return pillbox is a predictor of being lost to follow-up among people living with HIV on antiretroviral therapy in rural Tanzania
JournalArticle (Originalarbeit in einer wissenschaftlichen Zeitschrift)
ID
4651762
Author(s)
Ndege, R. C.; Okuma, J.; Kalinjuma, A. V.; Mkumbo, J.; Senkoro, E.; Fue, G.; Samson, L.; Mapesi, H.; Shabani, S.; Glass, T. R.; Battegay, M.; Paris, D. H.; Vanobberghen, F.; Weisser, M.; Kiularco Study Group,
Failure to return pillbox is a predictor of being lost to follow-up among people living with HIV on antiretroviral therapy in rural Tanzania
Journal
HIV Med
Volume
23
Number
6
Pages / Article-Number
661-672
Keywords
HIV treatment outcome; adherence; antiretroviral treatment; lost to follow-up; pillbox; rural; stigma; sub-Saharan Africa
Mesh terms
Adult; Anti-Retroviral Agents, therapeutic use; CD4 Lymphocyte Count; Female; HIV Infections, drug therapy; Humans; Lost to Follow-Up; Male; Tanzania, epidemiology
Abstract
OBJECTIVES: Pill count is used to assess drug adherence in people living with HIV (PLHIV). Carrying a pillbox is associated with fear of concealment and stigma and might indicate poor adherence and predict someone who will be lost to follow-up (LTFU). We therefore assessed the association between pillbox return and being LTFU in rural Tanzania. METHODS: This is a nested study of the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO). We included PLHIV aged >/= 18 years enrolled in KIULARCO between January 2013 and March 2019 with follow-up through January 2020, who were on antiretroviral treatment (ART) for >/= 6 months. Baseline was defined as the latest ART initiation or KIULARCO enrolment. We determined the association between time-dependent failed pillbox return updated at every visit and LTFU using Kaplan-Meier estimation and Cox models. RESULTS: Among 2552 PLHIV included in the study, 1735 (68.0%) were female, 959 (40.3%) had a WHO stage III/IV and 1487 (66.4%) had a CD4 cell count < 350 cells/microL. The median age was 38.4 years [interquartile range (IQR): 31.7-46.2]. During a median follow-up of 33.1 months (IQR: 17.5-52.4), 909 (35.6%) participants were LTFU, 43 (1.7%) died and 194 (7.6%) had transferred to another clinic. The probability of being LTFU was higher among PLHIV with failed pillbox return than among those who returned their pillbox [30.0%, 95% confidence interval (CI): 26.8-33.2% vs. 19.4%, 95% CI: 17.4-21.6%, respectively, at 24 months (hazard ratio = 1.67, 95% CI: 1.46-1.90; p < 0.001)]. CONCLUSIONS: Failed pillbox return was associated with a higher risk of being LTFU and could be used as a simple tool to identify PLHIV for appropriate interventions to reduce their chance of being LTFU.
