Failure to return pillbox is a predictor of being lost to follow‐up among people living with HIV on antiretroviral therapy in rural Tanzania. Issue 6 (28th December 2021)

• Record Type: Journal Article
• Authors: Ndege, Robert C.; Okuma, James; Kalinjuma, Aneth V.; Mkumbo, Julius; Senkoro, Elizabeth; Fue, Gideon; Samson, Leila; Mapesi, Herry; Shabani, Siraji; Glass, Tracy R.; Battegay, Manuel; Paris, Daniel H.; Vanobberghen, Fiona; Weisser, Maja
• Other Names: Asantiel Aschola investigator.; Bani Farida investigator.; Battegay Manuel investigator.; Byakuzana Theonestina investigator.; Chale Adolphina investigator.; Chuwa Francisca investigator.; Eichenberger Anna investigator.; Francis Gideon investigator.; Furrer Hansjakob investigator.; Glass Tracy R. investigator.; Hwaya Speciosa investigator.; Kalinjuma Aneth V. investigator.; Kasuga Bryson investigator.; Katende Andrew investigator.; Kimera Namvua investigator.; Kivuma Bernard investigator.; Kisunga Yassin investigator.; Kitau Olivia investigator.; Klimkait Thomas investigator.; Luoga Ezekiel investigator.; Mapesi Herry investigator.; Mkulila Mengi investigator.; Mkumbo Julius investigator.; Mkusa Margareth investigator.; Mlembe Slyakus investigator.; Mnzava Dorcas K. investigator.; Mollel Gertrud J. investigator.; Moshi Lilian investigator.; Mossad Germana investigator.; Mpundunga Dolores investigator.; Mtandanguo Athumani investigator.; Myeya Selerine investigator.; Nahota Sanula investigator.; Ndaki Regina investigator.; Ndege Robert C. investigator.; Ngulukila Agatha investigator.; Nyuri Amina investigator.; Okuma James investigator.; Paris Daniel H. investigator.; Sambuta Aloyce investigator.; Samson Leila investigator.; Senkoro Elizabeth investigator.; Sikalengo George investigator.; Tarimo Jenifa investigator.; Temba Yvan investigator.; Utzinger Juerg investigator.; Vanobberghen Fiona investigator.; Wigay John investigator.; Wilson Herieth investigator.;
• Is Part Of: HIV medicine. Volume 23:Issue 6(2022)
• Page Start: 661
• Page End: 672
• Publication Date: 2021-12-28
• Subjects: adherence -- antiretroviral treatment -- HIV treatment outcome -- lost to follow‐up -- pillbox -- rural -- stigma -- sub‐Saharan Africa; HIV infections -- Treatment -- Periodicals; HIV-positive persons -- Periodicals; HIV infections -- Treatment -- Decision making -- Periodicals; 616.9792
• DOI: 10.1111/hiv.13223
• Languages: English
• ISSNs: 1464-2662

Abstract

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/µL. 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.