Abstract
Romaing Tep1,2 Sodara Chan1, Heng Sopheab1
- School of Public Health, the National Institute of Public Health, Ministry of Health, Phnom Penh, Cambodia
- Database Mangement Unit, National Center for HIV/AIDS, Dermatology and STDs
*Corresponding author: Romaing Tep, Email: tromaing@gmail.com
Key terms: Retention, PLHIV, ART, Associated factors, Cambodia
Introduction
Globally, by the end of 2018, there were 37.9 million of people living with HIV (PLHIV) included 36.2 million adults and 1.7 million children (<15 years). Of these numbers, about 10% (3.8 million) were living South-East Asia. Also, 23.3 million PLHIV were accessing to antiretroviral therapy (ART) that was about 62% of all PLHIV. However, PLHIV who were not retained in treatment are still a big threat to the global long-term success of ART. In Cambodia, despite the HIV response including care and treatment has been highly successful, there was limited knowledge of retention rate and its associated factors.
Methods
A retrospective analysis was conducted by using existing data from ART database. PLHIV enrolled in ART service from 2010 to 2018 through National Center for HIV/AIDS, Dermatology and STDs (NCHADS) database were included and followed up until the end of 2019 when the censoring of the analysis occurred. Kaplan–Meier method was used to estimate the probability of 12-month retention rate in care after the ART initiation. All demographic and clinical variables were included in the univariate and multivariate Cox proportional hazard regression to identify factors associated with poor retention.
Results
Of the 32,684 PLHIVs, 51.7% were men, with 6.8% were under 15 years old. The 12-month retention rate was 87.5% in 2011 and declined respectively from 86.6% to 84.0% in 2015. However, it slightly increased from 84.0% (2017) to 86.5% (2019). The retention in care gradually declined from 78.3%, 74.7%, 70.6% to 67.9% at 24, 36, 48 and 60-month follow-up, respectively. With reference to 0-14 years old patients, the patients who were 15-25 years old had adjusted Hazard Ratio (aHR) of 1.73 (95% CI: 1.54 to 1.94) and 26-50 age group (AHR=1.31, 95% CI: 1.15 to 1.49) as well as greater than 50 years old (aHR=1.33, 95% CI: 1.21 to 1.46). In comparison to the earlier stage patients (WHO stage I): stage III with aHR=1.14 (95% CI: 1.06 to 1.22); stage IV with aHR=1.24 (95% CI: 1.11 to 1.38). Patients with higher education level were retained in care better than those with no education with aHR=0.74 (95% CI: 0.69 to 0.79) for primary, aHR=0.65 (95% CI: 0.60 to 0.70) for secondary and aHR=0.36 (95% CI: 0.29 to 0.46) for the university level. Similarly, patients whose baseline CD4 count ? 200 had a better retention hazard (CD4 count >200-350, aHR=0.91 and CD4 count >350, aHR=0.73) than CD4 count <200.
Conclusions
The ART 12-month retention rate from 2011 to 2019 was stable between 84.0% to 86.5%. However, long-term retentions more than 12 months in care declined over time. Lower education, patients, advanced clinical stages and older patients were strongly associated with poor retention. We recommend further study on reasons for higher attrition particularly in the long-term care.