Social and Clinical attributes of patients who restart Antiretroviral Therapy at 5 ART Centers in Central and Copperbelt Provinces of Zambia

Abstract

Background: Treatment outcome of patients on antiretroviral therapy (ART) differ. Some patients default and restart ART. Family Health International (FHI360) in collaboration with Ministry of Health, has been supporting implementation of a program on HIV prevention, care and treatment (ART) services in Zambia and has been collecting routine data on patients who default and restart ART. This study aims to describe and determine the association between the socio-demographic and clinical characteristics of these patients. Methods: A longitudinal retrospective analysis of data from 535 adult patients restarting ART in 2009 to 2010 and attending ART care services at 5 ART centers in the Copperbelt and Central provinces of Zambia was performed. Patients who were less than 16 years and pregnant women were excluded. To determine the relationship between the socio-demographic characteristic and CD4 cell count over time, quantile regression models were used. Results: A total of 535 patients adults restarted ART of which 303(56.6%) were female. The proportion of patients that restarted was found to be 21.1%. Most of the patients who restarted ART were above the age of 35 years and had the mean weight of 55.5Kgs. A higher proportion of patients were married (60%, n=321), had attained the highest grade 1-12 (61.1%, n=327) and were either unemployed (35.5% n=190) or self-employed (36.4%, n=195). Female gender had a higher CD4 count by 22 at 6 months and patients in self and formal employment showed an increase in CD4 count. Baseline CD4 count, type of treatment, WHO staging, total duration on treatment, duration lost to follow-up (LTFU) and duration before defaulting were found to be strong predictors of CD4 cell count at 6, 12, 18 and 24 months after restarting ART. Conclusion: Gender, age of the patient and occupation were the only socio-demographic characteristics predicting CD4 count. The predictors of CD4 count in patients who restart ART are similar to the predictors of CD4 count of patients newly initiated on ART.