AUTHOR=Raberahona Mihaja , Rakotomalala Rado , Andriananja Volatiana , Andriamamonjisoa Johary , Rakotomijoro Etienne , Andrianasolo Radonirina Lazasoa , Rakotoarivelo Rivonirina Andry , Randria Mamy Jean de Dieu 

TITLE=A retrospective cohort analysis of people living with HIV/AIDS enrolled in HIV care at a reference center in Antananarivo, Madagascar

JOURNAL=Frontiers in Public Health

VOLUME=Volume 11 - 2023

YEAR=2024

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1329194

DOI=10.3389/fpubh.2023.1329194

ISSN=2296-2565

ABSTRACT=The impact of “Treat all” policy on the individual and in terms of public health is closely related to early diagnosis and retention in care. Patient-level data are scarce in Madagascar. In this study, we aimed to describe the profile of a cohort of newly diagnosed people living with HIV/AIDS (PLHIV), to identify their outcome, and to assess factors associated with attrition from care and advanced HIV disease (AHD) at presentation.
We conducted a retrospective cohort study in PLHIV aged ≥15 newly diagnosed at the University Hospital Joseph Raseta Befelatanana Antananarivo from 01/01/2010 to 31/12/2016. 
A total of 490 PLHIV were included in the cohort analysis. A total of 67.1% were male. The median age (interquartile range) at enrollment in care was 29 years (24-38). Overall, 36.1% of PLHIV were diagnosed with AHD at baseline. The proportion of patients with WHO stage IV at baseline significantly increased from 3.3% in 2010 to 31% in 2016 (p=0.001 for trend). The probability of retention in care after the diagnosis at 12 months, 24 months and 36 months was 71.8%, 65.5% and 61.3% respectively. Age≥40 years (aHR:1.55; 95%CI:1.05-2.29; p=0.026), low level of education (aHR:1.62; 95%CI:1.11-2.36; p=0,013), unspecified level of education (aHR:2.18; 95%CI:1.37-3.47; p=0.001) and unemployment (aHR:1.52; 95%CI:1.07-2.16; p=0.019) were independently associated with attrition from care. Factors associated with AHD at baseline were age≥40 (aOR: 2.77; 95%CI: 1.38-5.57, p=0.004), unspecified level of education (aOR:3.80; 95% CI: 1.58-9.16, p=0.003) and presence of clinical symptoms at baseline (aOR:23.81; 95% CI: 10.7-52.98; p<0.001). Sex workers are independently less likely to have an AHD at presentation (aOR: 0.23; 95%CI: 0.05-0.96, p=0.044).
Sociodemographic determinants influenced retention in care more than clinical factors. The presence of clinical symptoms and sociodemographic determinants were the major factors associated with AHD at baseline.