Advanced HIV disease and associated attrition after re-engagement in HIV care in Myanmar from 2003 to 2019: a retrospective cohort study

Anita Mesic; Tobias Homan; Annick Lenglet; Phone Thit; Htay Thet Mar; Saw Myat Sabai; Moe Pyae Thandar; Thin Thin Thwe; Aung Aung Kyaw; Tom Decroo; Alexander Spina; Cono Ariti; Koert Ritmeijer; Josefien Van Olmen; Htun Nyunt Oo; Lutgarde Lynen

doi:10.1093/inthealth/ihac069

Advanced HIV disease and associated attrition after re-engagement in HIV care in Myanmar from 2003 to 2019: a retrospective cohort study

Anita Mesic, Tobias Homan, Annick Lenglet, Phone Thit, Htay Thet Mar, Saw Myat Sabai, Moe Pyae Thandar, Thin Thin Thwe, Aung Aung Kyaw, Tom Decroo, Alexander Spina, Cono Ariti, Koert Ritmeijer, Josefien Van Olmen, Htun Nyunt Oo, Lutgarde Lynen

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Abstract

BACKGROUND: The burden of advanced HIV disease (AHD) and predictors of outcomes among people living with HIV (PLHIV) re-engaging in care are not well known.

METHODS: We conducted a retrospective cohort study of PLHIV who re-engaged in care after being lost to follow-up (LFU), from 2003 to 2019, in Myanmar. We calculated the incidence rates of attrition after re-engagement and performed Cox regression to identify risk factors for attrition.

RESULTS: Of 44 131 PLHIV who started antiretroviral treatment, 12 338 (28.0%) were LFU at least once: 7608 (61.6%) re-engaged in care, 4672 (61.4%) with AHD at re-engagement. The death and LFU rates were 2.21-fold (95% CI 1.82 to 2.67) and 1.46-fold (95% CI 1.33 to 1.61) higher among patients who re-engaged with AHD (p>0.001). Death in patients who re-engaged with AHD was associated with male sex (adjusted HR [aHR] 2.63; 95% CI 1.31 to 5.26; p=0.006), TB coinfection (aHR 2.26; 95% CI 1.23 to 4.14; p=0.008) and sex work (aHR 7.49, 95% CI 2.29 to 22.52; p<0.001). History of intravenous drug use was identified as a predictor of being LFU.

CONCLUSIONS: Re-engagement in HIV care in Myanmar is frequent and those who re-engage carry a high burden of AHD. As AHD at re-engagement is associated with higher attrition rates, implementation of differentiated interventions that enable earlier linkage to care and prompt identification and management of AHD in this population is necessary.

Original language	English
Article number	ihac069
Journal	International Health
Number of pages	9
ISSN	1876-3405
DOIs	https://doi.org/10.1093/inthealth/ihac069
Publication status	E-pub ahead of print - 2022

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10.1093/inthealth/ihac069Licence: CC BY-NC

2022iheaihac069Final published version, 455 KBLicence: CC BY-NC

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Mesic, A., Homan, T., Lenglet, A., Thit, P., Mar, H. T., Sabai, S. M., Thandar, M. P., Thwe, T. T., Kyaw, A. A., Decroo, T., Spina, A., Ariti, C., Ritmeijer, K., Van Olmen, J., Oo, H. N., & Lynen, L. (2022). Advanced HIV disease and associated attrition after re-engagement in HIV care in Myanmar from 2003 to 2019: a retrospective cohort study. International Health, Article ihac069. Advance online publication. https://doi.org/10.1093/inthealth/ihac069

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title = "Advanced HIV disease and associated attrition after re-engagement in HIV care in Myanmar from 2003 to 2019: a retrospective cohort study",

abstract = "BACKGROUND: The burden of advanced HIV disease (AHD) and predictors of outcomes among people living with HIV (PLHIV) re-engaging in care are not well known.METHODS: We conducted a retrospective cohort study of PLHIV who re-engaged in care after being lost to follow-up (LFU), from 2003 to 2019, in Myanmar. We calculated the incidence rates of attrition after re-engagement and performed Cox regression to identify risk factors for attrition.RESULTS: Of 44 131 PLHIV who started antiretroviral treatment, 12 338 (28.0%) were LFU at least once: 7608 (61.6%) re-engaged in care, 4672 (61.4%) with AHD at re-engagement. The death and LFU rates were 2.21-fold (95% CI 1.82 to 2.67) and 1.46-fold (95% CI 1.33 to 1.61) higher among patients who re-engaged with AHD (p>0.001). Death in patients who re-engaged with AHD was associated with male sex (adjusted HR [aHR] 2.63; 95% CI 1.31 to 5.26; p=0.006), TB coinfection (aHR 2.26; 95% CI 1.23 to 4.14; p=0.008) and sex work (aHR 7.49, 95% CI 2.29 to 22.52; p<0.001). History of intravenous drug use was identified as a predictor of being LFU.CONCLUSIONS: Re-engagement in HIV care in Myanmar is frequent and those who re-engage carry a high burden of AHD. As AHD at re-engagement is associated with higher attrition rates, implementation of differentiated interventions that enable earlier linkage to care and prompt identification and management of AHD in this population is necessary.",

author = "Anita Mesic and Tobias Homan and Annick Lenglet and Phone Thit and Mar, {Htay Thet} and Sabai, {Saw Myat} and Thandar, {Moe Pyae} and Thwe, {Thin Thin} and Kyaw, {Aung Aung} and Tom Decroo and Alexander Spina and Cono Ariti and Koert Ritmeijer and {Van Olmen}, Josefien and Oo, {Htun Nyunt} and Lutgarde Lynen",

note = "FTX; (CC BY-NC 4.0)",

year = "2022",

doi = "10.1093/inthealth/ihac069",

language = "English",

journal = "International Health",

issn = "1876-3405",

publisher = "Oxford University Press",

}

Mesic, A, Homan, T, Lenglet, A, Thit, P, Mar, HT, Sabai, SM, Thandar, MP, Thwe, TT, Kyaw, AA, Decroo, T, Spina, A, Ariti, C, Ritmeijer, K, Van Olmen, J, Oo, HN & Lynen, L 2022, 'Advanced HIV disease and associated attrition after re-engagement in HIV care in Myanmar from 2003 to 2019: a retrospective cohort study', International Health. https://doi.org/10.1093/inthealth/ihac069

TY - JOUR

T1 - Advanced HIV disease and associated attrition after re-engagement in HIV care in Myanmar from 2003 to 2019: a retrospective cohort study

AU - Mesic, Anita

AU - Homan, Tobias

AU - Lenglet, Annick

AU - Thit, Phone

AU - Mar, Htay Thet

AU - Sabai, Saw Myat

AU - Thandar, Moe Pyae

AU - Thwe, Thin Thin

AU - Kyaw, Aung Aung

AU - Decroo, Tom

AU - Spina, Alexander

AU - Ariti, Cono

AU - Ritmeijer, Koert

AU - Van Olmen, Josefien

AU - Oo, Htun Nyunt

AU - Lynen, Lutgarde

N1 - FTX; (CC BY-NC 4.0)

PY - 2022

Y1 - 2022

N2 - BACKGROUND: The burden of advanced HIV disease (AHD) and predictors of outcomes among people living with HIV (PLHIV) re-engaging in care are not well known.METHODS: We conducted a retrospective cohort study of PLHIV who re-engaged in care after being lost to follow-up (LFU), from 2003 to 2019, in Myanmar. We calculated the incidence rates of attrition after re-engagement and performed Cox regression to identify risk factors for attrition.RESULTS: Of 44 131 PLHIV who started antiretroviral treatment, 12 338 (28.0%) were LFU at least once: 7608 (61.6%) re-engaged in care, 4672 (61.4%) with AHD at re-engagement. The death and LFU rates were 2.21-fold (95% CI 1.82 to 2.67) and 1.46-fold (95% CI 1.33 to 1.61) higher among patients who re-engaged with AHD (p>0.001). Death in patients who re-engaged with AHD was associated with male sex (adjusted HR [aHR] 2.63; 95% CI 1.31 to 5.26; p=0.006), TB coinfection (aHR 2.26; 95% CI 1.23 to 4.14; p=0.008) and sex work (aHR 7.49, 95% CI 2.29 to 22.52; p<0.001). History of intravenous drug use was identified as a predictor of being LFU.CONCLUSIONS: Re-engagement in HIV care in Myanmar is frequent and those who re-engage carry a high burden of AHD. As AHD at re-engagement is associated with higher attrition rates, implementation of differentiated interventions that enable earlier linkage to care and prompt identification and management of AHD in this population is necessary.

AB - BACKGROUND: The burden of advanced HIV disease (AHD) and predictors of outcomes among people living with HIV (PLHIV) re-engaging in care are not well known.METHODS: We conducted a retrospective cohort study of PLHIV who re-engaged in care after being lost to follow-up (LFU), from 2003 to 2019, in Myanmar. We calculated the incidence rates of attrition after re-engagement and performed Cox regression to identify risk factors for attrition.RESULTS: Of 44 131 PLHIV who started antiretroviral treatment, 12 338 (28.0%) were LFU at least once: 7608 (61.6%) re-engaged in care, 4672 (61.4%) with AHD at re-engagement. The death and LFU rates were 2.21-fold (95% CI 1.82 to 2.67) and 1.46-fold (95% CI 1.33 to 1.61) higher among patients who re-engaged with AHD (p>0.001). Death in patients who re-engaged with AHD was associated with male sex (adjusted HR [aHR] 2.63; 95% CI 1.31 to 5.26; p=0.006), TB coinfection (aHR 2.26; 95% CI 1.23 to 4.14; p=0.008) and sex work (aHR 7.49, 95% CI 2.29 to 22.52; p<0.001). History of intravenous drug use was identified as a predictor of being LFU.CONCLUSIONS: Re-engagement in HIV care in Myanmar is frequent and those who re-engage carry a high burden of AHD. As AHD at re-engagement is associated with higher attrition rates, implementation of differentiated interventions that enable earlier linkage to care and prompt identification and management of AHD in this population is necessary.

U2 - 10.1093/inthealth/ihac069

DO - 10.1093/inthealth/ihac069

M3 - A1: Web of Science-article

C2 - 36318805

SN - 1876-3405

JO - International Health

JF - International Health

M1 - ihac069

ER -

Advanced HIV disease and associated attrition after re-engagement in HIV care in Myanmar from 2003 to 2019: a retrospective cohort study

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