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. 2024 Jul 1;38(8):1198-1205.
doi: 10.1097/QAD.0000000000003859. Epub 2024 Feb 7.

The effect of care interruptions on mortality in adults resuming antiretroviral therapy

Haroon Moolla  1 , Mary-Ann Davies  1 , Claire Davies  2 , Jonathan Euvrard  1 , Hans W Prozesky  3 , Matthew P Fox  4 , Catherine Orrell  5 , Per Von Groote  6 , Leigh F Johnson  1 ; International epidemiology Databases to Evaluate AIDS Southern Africa (IeDEA-SA) Collaboration
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The effect of care interruptions on mortality in adults resuming antiretroviral therapy

Haroon Moolla et al. AIDS. .

Abstract

Objective: To estimate the relative rate of all-cause mortality amongst those on antiretroviral treatment (ART) with a history of interruptions compared with those with no previous interruptions in care.

Design: Retrospective cohort study.

Methods: We used data from four South African cohorts participating in the International epidemiology Databases to Evaluate AIDS Southern Africa collaboration. We included adults who started ART between 2004 and 2019. We defined a care interruption as a gap in contact longer than 180 days. Observation time prior to interruption was allocated to a 'no interruption' group. Observation time after interruption was allocated to one of two groups based on whether the first interruption started before 6 months of ART ('early interruption') or later ('late interruption'). We used Cox regression to estimate hazard ratios.

Results: Sixty-three thousand six hundred and ninety-two participants contributed 162 916 person-years of observation. There were 3469 deaths. Most participants were female individuals (67.4%) and the median age at ART initiation was 33.3 years (interquartile range: 27.5-40.7). Seventeen thousand and eleven (26.7%) participants experienced care interruptions. Those resuming ART experienced increased mortality compared with those with no interruptions: early interrupters had a hazard ratio of 4.37 (95% confidence interval (CI) 3.87-4.95) and late interrupters had a hazard ratio of 2.74 (95% CI 2.39-3.15). In sensitivity analyses, effect sizes were found to be proportional to the length of time used to define interruptions.

Conclusion: Our findings highlight the need to improve retention in care, regardless of treatment duration. Programmes to encourage return to care also need to be strengthened.

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Conflict of interest statement

The authors declare that they have no competing interests. Research reported in this publication was supported by the U.S. National Institutes of Health’s National Institute of Allergy and Infectious Diseases (NIAID), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the National Cancer Institute (NCI), the National Institute on Drug Abuse (NIDA), the National Heart, Lung, and Blood Institute (NHLBI), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the Fogarty International Center (FIC) under Award Number U01AI069924. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funding body did not have any role in the design of the study, data analysis, interpretation of results, or writing of the manuscript.

Figures

Figure 1.
Figure 1.
Survival curves by interruption status (for the primary analysis) with 95% confidence intervals shown as shaded areas
See this image and copyright information in PMC

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