Comparison of retention in care rates among HIV-infected older persons and young adults on higly active antiretroviral therapy at a tertiary hospital in Harare, Zimbabwe

Abstract

Objective: To evaluate differences in retention in care rates between older individuals and young adults initiated on HAART and to determine the baseline characteristics that are associated with retention in care. Design: Retrospective cohort study using routinely collected clinic data Setting: A public sector HIV adult facility at the Parirenyatwa Hospital Family Care Centre, Harare, Zimbabwe. Participants: 444 HIV infected elderly patients (age 50 years and above) and young adults (age 25 to <50 years) who initiated HAART between 1 January 2009 and 31 December 2011. Main outcome measures: Primary outcome: Retention rate among older individuals (=50 years) compared to younger individuals(25-49 years). Secondary outcomes: Factors associated with attrition. Methods: Analysis of patient records was done. Survival analyses were performed using Kaplan-Meier method. Univariate analyses were done to determine factors associated with retention in care. Results: Older individuals had a significantly lower retention in care rate than young adults(67.0% versus 81.8%) after 24 months on HAART in the final survival analysis(p<0.0001). Baseline CD4+ T-cell counts were significantly lower in the older age group(p=0.042) who also presented with more advanced WHO clinical stages 3 and 4(p<0.0001). Time from HIV diagnosis to HAART initiation was significantly shorter in older persons compared to younger individuals(31days versus 47.5days). In the older age group, baseline characteristics associated with attrition were WHO clinical stage 3and 4 OR 3.11 p=0.048[95%CI:1.96-4.05, CD4+ T-cell counts=100cells/mm³ OR 2.27 p=0.041 [95% CI: 1.82-3.22 ]and presence of at least one co-morbidity OR 2.07 p=0.028 [CI:1.71-6.02]. Conclusion: Retention in care was lower in older persons as compared to younger individuals. Older patients need to be tested for HIV and commenced on HAART early in order to maintain their continuity in care and prevent death.