Implementation of free cotrimoxazole prophylaxis improves clinic retention among antiretroviral therapy-ineligible clients in Kenya

Pamela K. Kohler, Michael H. Chung, Christine J. McGrath, Sarah F. Benki-Nugent, Joan W. Thiga, Grace C. John-Stewart

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Objective: To determine whether implementation of free cotrimoxazole (CTX) provision was associated with improved retention among clients ineligible for antiretroviral therapy (ART) enrolled in an HIV treatment program in Kenya. Design: Data were obtained from a clinical cohort for program evaluation purposes. Twelve-month clinic retention was compared among ART-ineligible clients enrolled in the time period before free CTX versus the time period after. Methods: Statistical comparisons were made using Kaplan-Meier survival curves, log-rank tests, and multivariate Cox proportional hazards models. To exclude potential temporal program changes that may have influenced retention, ART clients before and after the same cut-off date were compared. Findings: Among adult clients enrolled between 2005 and 2007, 3234 began ART within 1 year of enrollment, and 1024 of those who did not start treatment were defined as ART-ineligible. ART-ineligible clients enrolled in the period following free CTX provision had higher 12-month retention (84%) than those who enrolled prior to free CTX (63%; P < 0.001). Retention did not change significantly during these periods among ART clients (P = 0.55). In multivariate analysis, ART-ineligible clients enrolled prior to free CTX were more than twice as likely to be lost to follow-up compared to those following free CTX [adjusted hazard ratio (aHR) = 2.64, 95% confidence interval 1.95-3.57, P < 0.001]. Conclusion: Provision of free CTX was associated with significantly improved retention among ART-ineligible clients. Retention and CD4-monitoring of ART-ineligible clients are essential to promptly identify ART eligibility and provide treatment. Implementation of free CTX may improve retention in sub-Saharan Africa and, via increasing timely ART initiation, provide survival benefit.

Original languageEnglish (US)
Pages (from-to)1657-1661
Number of pages5
JournalAIDS
Volume25
Issue number13
DOIs
StatePublished - Aug 24 2011
Externally publishedYes

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Kenya
Sulfamethoxazole Drug Combination Trimethoprim
Therapeutics
Africa South of the Sahara
Lost to Follow-Up
Program Evaluation
Kaplan-Meier Estimate
Proportional Hazards Models
Multivariate Analysis
HIV
Confidence Intervals

Keywords

  • antibiotic
  • HIV
  • lost to follow-up
  • prophylaxis
  • trimethoprim-sulfamethoxazole combination

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

Kohler, P. K., Chung, M. H., McGrath, C. J., Benki-Nugent, S. F., Thiga, J. W., & John-Stewart, G. C. (2011). Implementation of free cotrimoxazole prophylaxis improves clinic retention among antiretroviral therapy-ineligible clients in Kenya. AIDS, 25(13), 1657-1661. https://doi.org/10.1097/QAD.0b013e32834957fd

Implementation of free cotrimoxazole prophylaxis improves clinic retention among antiretroviral therapy-ineligible clients in Kenya. / Kohler, Pamela K.; Chung, Michael H.; McGrath, Christine J.; Benki-Nugent, Sarah F.; Thiga, Joan W.; John-Stewart, Grace C.

In: AIDS, Vol. 25, No. 13, 24.08.2011, p. 1657-1661.

Research output: Contribution to journalArticle

Kohler, PK, Chung, MH, McGrath, CJ, Benki-Nugent, SF, Thiga, JW & John-Stewart, GC 2011, 'Implementation of free cotrimoxazole prophylaxis improves clinic retention among antiretroviral therapy-ineligible clients in Kenya', AIDS, vol. 25, no. 13, pp. 1657-1661. https://doi.org/10.1097/QAD.0b013e32834957fd
Kohler, Pamela K. ; Chung, Michael H. ; McGrath, Christine J. ; Benki-Nugent, Sarah F. ; Thiga, Joan W. ; John-Stewart, Grace C. / Implementation of free cotrimoxazole prophylaxis improves clinic retention among antiretroviral therapy-ineligible clients in Kenya. In: AIDS. 2011 ; Vol. 25, No. 13. pp. 1657-1661.
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abstract = "Objective: To determine whether implementation of free cotrimoxazole (CTX) provision was associated with improved retention among clients ineligible for antiretroviral therapy (ART) enrolled in an HIV treatment program in Kenya. Design: Data were obtained from a clinical cohort for program evaluation purposes. Twelve-month clinic retention was compared among ART-ineligible clients enrolled in the time period before free CTX versus the time period after. Methods: Statistical comparisons were made using Kaplan-Meier survival curves, log-rank tests, and multivariate Cox proportional hazards models. To exclude potential temporal program changes that may have influenced retention, ART clients before and after the same cut-off date were compared. Findings: Among adult clients enrolled between 2005 and 2007, 3234 began ART within 1 year of enrollment, and 1024 of those who did not start treatment were defined as ART-ineligible. ART-ineligible clients enrolled in the period following free CTX provision had higher 12-month retention (84{\%}) than those who enrolled prior to free CTX (63{\%}; P < 0.001). Retention did not change significantly during these periods among ART clients (P = 0.55). In multivariate analysis, ART-ineligible clients enrolled prior to free CTX were more than twice as likely to be lost to follow-up compared to those following free CTX [adjusted hazard ratio (aHR) = 2.64, 95{\%} confidence interval 1.95-3.57, P < 0.001]. Conclusion: Provision of free CTX was associated with significantly improved retention among ART-ineligible clients. Retention and CD4-monitoring of ART-ineligible clients are essential to promptly identify ART eligibility and provide treatment. Implementation of free CTX may improve retention in sub-Saharan Africa and, via increasing timely ART initiation, provide survival benefit.",
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N2 - Objective: To determine whether implementation of free cotrimoxazole (CTX) provision was associated with improved retention among clients ineligible for antiretroviral therapy (ART) enrolled in an HIV treatment program in Kenya. Design: Data were obtained from a clinical cohort for program evaluation purposes. Twelve-month clinic retention was compared among ART-ineligible clients enrolled in the time period before free CTX versus the time period after. Methods: Statistical comparisons were made using Kaplan-Meier survival curves, log-rank tests, and multivariate Cox proportional hazards models. To exclude potential temporal program changes that may have influenced retention, ART clients before and after the same cut-off date were compared. Findings: Among adult clients enrolled between 2005 and 2007, 3234 began ART within 1 year of enrollment, and 1024 of those who did not start treatment were defined as ART-ineligible. ART-ineligible clients enrolled in the period following free CTX provision had higher 12-month retention (84%) than those who enrolled prior to free CTX (63%; P < 0.001). Retention did not change significantly during these periods among ART clients (P = 0.55). In multivariate analysis, ART-ineligible clients enrolled prior to free CTX were more than twice as likely to be lost to follow-up compared to those following free CTX [adjusted hazard ratio (aHR) = 2.64, 95% confidence interval 1.95-3.57, P < 0.001]. Conclusion: Provision of free CTX was associated with significantly improved retention among ART-ineligible clients. Retention and CD4-monitoring of ART-ineligible clients are essential to promptly identify ART eligibility and provide treatment. Implementation of free CTX may improve retention in sub-Saharan Africa and, via increasing timely ART initiation, provide survival benefit.

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