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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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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
slide18
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