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Setting and Origin of Data

Changes in baseline characteristics and retention during scaling-up of ART: cohort-assessment 2005 to 2010, rural Lesotho. Niklaus D. Labhardt, Motlalepula Sello , Jan S. Emmel , Masetsibi Motlomelo , Thomas Gass , Karolin Pfeiffer, M.A. Mohlaba , Jochen Ehmer.

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Setting and Origin of Data

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  1. Changes in baselinecharacteristics and retentionduringscaling-up of ART: cohort-assessment 2005 to 2010, rural Lesotho Niklaus D. Labhardt, MotlalepulaSello, Jan S. Emmel, MasetsibiMotlomelo, Thomas Gass, Karolin Pfeiffer, M.A. Mohlaba, Jochen Ehmer

  2. Setting and Origin of Data Seboche 1 hospital, 5 health centers Population: ~ 55‘000 Adult prevalence*: ~ 16% • AdultHIV-prevalence*: 23.6% • ART at hospitals: since 2005 • ART at health-centers: 2007/08 • SMART: SolidarMedanti-retroviraltreatmentproject Paray 1 hospital, 7 health centers Population: ~ 77‘000 Adult prevalence*: ~ 20% *Demographic Health Survey of Lesotho 2009

  3. Data-processing

  4. Objectives: To describefrom 2005 to 2010 • change in scaling-up • change in baseline-characteristics • Short-termretention in care

  5. Number of patients initiated on ART per year

  6. Continuation of trendfirst-half 2011 EstimatedadultART-coverage: 50%

  7. CD4-count at initiation of ART

  8. Clinical WHO-stage at initiation of ART

  9. No follow-up after ART-initiation

  10. No follow-up after ART-initiation OR: 1.50 (1.18, 1.91)

  11. No follow-up after ART-initiation OR: 1.50 (1.18, 1.91)

  12. One-year retention on ART

  13. One-year retention on ART OR: 0.89 (0.75, 1.06)

  14. One-year retention on ART OR: 0.89 (0.75, 1.06)

  15. Summary • Scaling-upslows down despitedecentralization to health-centers • Furtherdecentralization? • Patients initiated at an earlierclinicalstage • reduction of proportionwithoutanyfollow-upafterinitiation (earlymortality) • No improvement in one-yearretention • Benefit of earlyinitiationdoesnottranslateintobetterretention

  16. Acknowledgements

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