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Changes in ART Baseline Characteristics and Retention During Scaling-Up in Rural Lesotho (2005-2010)

This study assesses the changes in baseline characteristics and retention rates for antiretroviral therapy (ART) in rural Lesotho from 2005 to 2010. The analysis includes data from Seboche Hospital and surrounding health centers, observing shifts in patient demographics and retention trends after ART initiation. Despite efforts to decentralize ART services, the findings indicate a slowdown in scaling up, with patients starting treatment at earlier clinical stages but no significant improvement in one-year retention rates. The study highlights challenges in translating early ART initiation benefits into sustained care.

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Changes in ART Baseline Characteristics and Retention During Scaling-Up in Rural Lesotho (2005-2010)

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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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