摘要：Jean Wysler Domercant a* http://orcid.org/0000-0001-7995-4111 , Nancy Puttkammer b , Paul Young c http://orcid.org/0000-0002-5564-9486 , Krista Yuhas d , Kesner François e , Reynold Grand’Pierre f , David Lowrance a & Michelle Adler ga Division of Global HIV & TB , Centers for Disease Control and Prevention , Port au Prince , Haiti b International Training and Education Center for Health , University of Washington , Seattle , WA , USA c Division of Global HIV/AIDS , Centers for Disease Control and Prevention , Atlanta , GA , USA d Center for AIDS Research , University of Washington , Seattle , WA , USA e National AIDS Control Program , Ministry of Health of the Government of Haiti f Department of Family Health , Ministry of Health of the Government of Haiti g Division of Global HIV & TB , Centers for Disease Control and Prevention , Kampala , Uganda JWD, NP, MA, PY, and DL greatly contributed to conception of this project. JWD, NP, RGP, and KF contributed towards data acquisition. NP and KY conducted the primary data analysis. JWD, NP, MA, PY, KY, KF, and RGP contributed to data interpretation. JWD and NP drafted the manuscript. All authors critically reviewed the work and approved the final content for publication. CONTACT Jean Wysler Domercant viw5@cdc.gov Centers for Disease Control and Prevention, US Embassy , Port au Prince , Haiti Data presented at : 8th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2015), Vancouver Convention Centre, 19–22 July 2015, Vancouver, Canada. Background : Access to antiretroviral therapy (ART) has expanded in Haiti because of the adoption of Option B+ and the revision of treatment guidelines. Retention in care and treatment varies greatly and few studies have examined retention rates, particularly among women enrolled in Option B+. Objective : To assess attrition among pregnant and non-pregnant patients initiating ART following adoption of Option B+ in Haiti. Methods : Longitudinal data of adult patients initiated on ART from October 2012 through August 2014 at 73 health facilities across Haiti were analyzed using a survival analysis framework to determine levels of attrition. The Kaplan–Meier method and Cox proportional hazards regression were used to examine risk factors associated with attrition. Results : Among 17,059 patients who initiated ART, 7627 (44.7%) were non-pregnant women, 5899 (34.6%) were men, and 3533 (20.7%) were Option B+ clients. Attrition from the ART program was 36.7% at 12 months (95% CI: 35.9–37.5%). Option B+ patients had the highest level of attrition at 50.4% at 12 months (95% CI: 48.6–52.3%). While early HIV disease stage at ART initiation was protective among non-pregnant women and men, it was a strong risk factor among Option B+ clients. In adjusted analyses, key protective factors were older age (p < 0.0001), living near the health facility (p = 0.04), having another known HIV-positive household member (p < 0.0001), having greater body mass index (BMI) (p < 0.0001), pre-ART counseling (p < 0.0001), and Cotrimoxazole prophylaxis during baseline (p < 0.01). Higher attrition was associated with rapidly starting ART after enrollment (p < 0.0001), anemia (p < 0.0001), and regimen tenofovir+lamivudine+nevirapine (TDF+3TC+NVP) (p < 0.001). Conclusions : ART attrition in Haiti is high among adults, especially among Option B+ patients. Identifying newly initiated patients most at risk for attrition and providing appropriate interventions could help reduce ART attrition.
