Background
Fishing communities are
potentially suitable for Human immunodeficiency virus (HIV) efficacy trials due
to their high risk profile. However, high mobility and attrition could decrease
statistical power to detect the impact of a given intervention. We report
dropout and associated factors in a fisher-folk observational cohort in Uganda.
Methods
Human immunodeficiency
virus-uninfected high-risk volunteers aged 13–49 years living in five
fishing communities around Lake Victoria were enrolled and followed every
6 months for 18 months at clinics located within each community.
Volunteers from two of the five communities had their follow-up periods
extended to 30 months and were invited to attend clinics 10–40 km
(km) away from their communities. Human immunodeficiency virus counseling and
testing was provided, and data on sexual behaviour collected at all study
visits. Study completion was defined as completion of 18 or 30 months or
visits up to the date of sero-conversion and dropout as missing one or more visits.
Discrete time survival models were fitted to find factors independently
associated with dropout.
Results
A total of 1000
volunteers (55 % men) were enrolled. Of these, 91.9 % completed
6 months, 85.2 % completed 12 months and 76.0 % completed
18 months of follow-up. In the two communities with additional follow-up,
76.9 % completed 30 months. In total 299 (29.9 %) volunteers
missed at least one visit (dropped out). Dropout was independently associated
with age (volunteers aged 13–24 being most likely to dropout), gender [men
being more likely to dropout than women [adjusted hazard ratio (aHR) 1.4;
95 % confidence interval (CI) 1.1–1.8)], time spent in the fishing
community (those who stayed <1 year being most likely to dropout),
History of marijuana use (users being more likely to dropout than non-users
[1.7; (1.2–2.5)], ethnicity (non-Baganda being more likely to dropout than
Baganda [1.5; (1.2–1.9)], dropout varied between the five fishing communities,
having a new sexual partner in the previous 3 months [1.3 (1.0–1.7)] and
being away from home for ≥2 nights in the month preceding the interview [1.4
(1.1–1.8)].
Conclusion
Despite a substantial
proportion dropping out, retention was sufficient to suggest that by
incorporating retention strategies it will be possible to conduct HIV
prevention efficacy trials in this community.
...The results suggest a number of factors that are associated
with dropout from the fisher-folk cohort including young age, male gender,
ethnicity, having a new sexual partner, time spent in the fishing communities,
being away from home for ≥2 nights and marijuana use. Consistent with other
studies in the neighbouring fishing [8] and non-fishing communities [9, 10], USA [15] and Brazil [16], study dropout was associated with age,
with those in the youngest age group (13–24) being most likely to dropout.
Since there were nearly equal proportions of men (49 %) and women
(51 %) in this age group, this could be due to both looking for work and
new relationships.
Dropping out was associated with the ethnicity of the
volunteers, with non-Baganda being more likely to dropout. This has been
indicated in the previous study further North of Lake Victoria [8]. The majority of non-Baganda volunteers
come from further afield, including neighbouring countries (Kenya, Tanzania and
Rwanda) and some are traders and transporters who might spend relatively long
periods away from the fishing communities. These were more likely to be
involved in fishing or related activities compared to the Baganda who were
likely to be engaged in small scale businesses. Furthermore, number of years
spent in the fishing site was independently associated with study dropout, with
those who have spent more than 1 year in the fishing communities being
less likely to dropout. This further demonstrates that individuals who have
lived in a community for a long time are more likely to be available for
recruitment in prevention studies. Additionally these could easily be retained
in study follow up. The finding that dropout was associated with use of
marijuana is consistent with findings from cohorts in the USA [17] and Japan [18], where similar dropout rates were observed
among illicit drug users.
In this cohort we ascertained the frequency of reporting a
new sexual partner for both men and women and this was independently associated
with cohort dropout. This is consistent with the results from the inland
non-fishing community in which the reported number of lifetime partners was
higher in those who changed residence to other neighboring villages and there
was also more risky sexual behavior reported among those who changed residence
[14]. The fact that higher risk volunteers were
more likely to drop out could lead to underestimation of HIV incidence in a
prevention trial...
Full article at: http://goo.gl/fzVnth
By: Andrew Abaasa, Gershim Asiki, Juliet Mpendo, Jonathan Levin, Janet Seeley, Leslie Nielsen, Ali Ssetaala, Annet Nanvubya, Jan De Bont, Pontiano Kaleebu, and Anatoli Kamali
Uganda Research
Unit on AIDS, Medical Research Council/Uganda Virus Research Institute
(MRC/UVRI), P.O Box 49, Entebbe, Uganda
Uganda Virus
Research Institute/International AIDS Vaccine Initiative (UVRI/IAVI)-HIV
Vaccine Program, Entebbe, Uganda
London School of
Hygiene and Tropical Medicine, London, UK
International
AIDS Vaccine Initiative, New York, USA
Faculty of Health
Sciences, School of Public Health, University of the Witwatersrand,
Johannesburg, South Africa
Andrew Abaasa, Phone: 256 (0)417 704000, Email: gro.adnagucrm@asaabA.werdnA, Email: moc.oohay@asaaba.werdna.
More at: https://twitter.com/hiv_insight
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