Assessing factors associated with attrition among older adults on antiretroviral therapy in Malawi
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Date
2021-10-18
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Kamuzu University of Health Sciences
Abstract
Type of research study: This quantitative study will employ a retrospective observational cohort
design.
The problem: Access to HIV services among adults aged ≥50 is compromised due to the
stereotypes surrounding their perceived low susceptibility to HIV. This leads to minimal
interventions targeting them as well as low follow-up for them after ART initiation. In SSA,
attrition after ART initiation ranges from 23.4% to 57% and is mainly due to either death or loss
to follow-up. Polypharmacy, drug toxicities, and co-infections increase the risk of attrition among
older adults. However, most HIV interventions primarily focus on populations aged 15-49 and
children neglecting those aged ≥50. There is still inadequate information on levels of attrition and
associated factors among these adults, hence the need for this study.
Broad objective:
To assess attrition after antiretroviral therapy initiation among adults at Nkhatabay district
hospital.
Specific objectives
• To compare levels of attrition between older and younger adults 24 months after ART
initiation
• To determine the predictors of mortality and loss to follow up among older adults 24
months after ART initiation.
Methodology: The study will be a quantitative retrospective observational cohort design. The
study will analyze outcomes of adults aged 15-49 and those aged ≥50 initiated on ART between
2015 and 2019 at Nkhatabay District Hospital. The sample size will be 208 and participants will
be selected using a simple random method. Data will be collected using patients' master cards and
ART registers. Data analysis will be done using STATA 14.0. Attrition post ART initiation will be
determined by the Kaplan-mier survival function. Cox proportional hazard model will be used to
measure factors associated with attrition.
Expected findings and their dissemination: It is expected that there will be variations in attrition
levels post ART initiation between older and younger adults. Predictors of attrition among older
adults will be ascertained. The study findings will be shared with the College of Medicine Research. Committee (COMREC), Nkhatabay District Office, the library of COM, and the Department of
HIV/AIDS at the Ministry of Health. The results will also be published and presented at research
conferences.
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Keywords
Research Subject Categories::MEDICINE