Retention and risk factors for attrition among adults in antiretroviral treatment programs in Tanzan...
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Retention and risk factors for attrition among adults in antiretroviral treatment programs in Tanzania, Uganda and Zambia Olivier Koole Institute of Tropical Medicine, Antwerp ICRH-Mozambique. Study Team. Family Health International (FHI 360)

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Study team

Retention and risk factors for attrition among adults in antiretroviral treatment programs in Tanzania, Uganda and ZambiaOlivier KooleInstitute of Tropical Medicine, AntwerpICRH-Mozambique


Study team

StudyTeam

  • Family Health International (FHI 360)

  • MuhimbiliUniversity of Health and Allied Sciences, Tanzania

  • Infectious Diseases Institute, Makerere University Medical School, Uganda

  • Tropical Diseases Research Centre, Zambia

  • Institute of Tropical Medicine, Belgium

  • Massachusetts General Hospital, USA

  • Centers for Disease Control and Prevention, USA

  • Gideon Kwesigabo

  • Fred Wabwire-Mangen

  • Modest Mulenga

  • David Bangsberg

  • JorisMenten

  • Robert Colebunders

  • Sharon Tsui

  • Eric Van Praag

  • Kwasi Torpey

  • YaDiulMukadi

  • Leine Stuart

  • Julie Denison

  • Andrew Auld

  • Simon Agolory

  • Seymour Williams

  • Jonathan Kaplan

  • Aaron Zee


Context

Context

  • Massive scale-up of ART: worldwide 8 million people on ART, 6.5 in sub-SaharanAfrica

  • Greatestincrease in coverage in SSA

  • Importance of retentionandadherenceforgoodclinicaloutcomes

  • Retention: critical determinant of adherenceand key indicator of quality of ART programs


Objectives

Objectives

Primary

  • To characterise the current level of retention of patients on ART across multiple programme settings

    Secondary

  • To identify important predictors of retention in care, including both individual risk factors and programmecharacteristics


Study population sites

TANZANIA

ZAMBIA

Study Population & Sites

  • Retrospective cohort study

  • StudyPopulation

    • 18 years and older at ART initiation at study site

    • Initiated 3 ARVs at least 6 months prior to data collection

  • Study sites

    • 3 countries

    • 6 sites per country, purposively selected

UGANDA


Source of data

Source of data

  • Retrospective cohort study – medicalchart review

    • April toAugust 2010, 250 medicalcharts/site randomlyselectedandreviewed: clinical records, laboratory register andpharmacylogbook

    • June to July 2011, Health Care Manager questionnaire at 18 sites for program characteristics


Sampling

Sampling

  • Sampling frame: all patients ever started on ART at that site

  • Random sample of 250 medicalcharts/site

  • Replacement strategy for ineligible patients

  • Screening logs:

    • eligible and abstracted

    • ineligible

    • missing


Methods

Methods

  • Retained patient: visit to one of the following services during the 90 days prior to data abstraction

    • Clinic

    • Laboratory

    • Pharmacy

  • Kaplan-Meier analysis

  • Attrition (=event): death or LTFU

    • transfer-outs censored at the time of transfer

  • Predictor analysis: Cox proportional hazard model, shared frailty effect


Patient accounting

Patient accounting


Selected characteristics at baseline art initiation

Selected characteristics at baseline (ART initiation)


Selected program characteristics 1

Selected program characteristics (1)


Program characteristics 2

Program characteristics (2)


L evels of retention

Levels of retention


Model building risk factors for attrition

Model building - risk factors for attrition


R isk factors of attrition multivariable analysis 1

Risk factors of attrition - Multivariable analysis (1)


Risk factors of attrition m ultivariable analysis 2

Risk factors of attrition - Multivariable analysis (2)


Risk factors of attrition multivariable analysis 3

Risk factors of attrition - Multivariable analysis (3)


Study team

Lower retention amongst men in programs without community dispensing but similar in programs with ARV dispensing

More difficultfor men tocometoclinicfor drug pick-up?


Conclusion

Conclusion

  • Wide variability in retentionratesamong different models of care

  • Importance of community ARV dispensing

    • Mobile clinics?

    • Community pharmacies?

    • Community ART groups?

  • Particularilyneeded for

    • Men

    • Younger persons

    • The very sick


Study team

Special thanks to our funders and partners:


Extra selected characteristics at baseline art initiation 2

Extra-Selected characteristics at baseline (ART initiation) (2)


Study team

Extra-Correction for sampling


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