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Factors Influencing Retention in HIV Treatment Programs in Sub-Saharan Africa

This study investigates retention and risk factors for attrition among adults in antiretroviral treatment programs in Tanzania, Uganda, and Zambia to improve patient adherence and program quality.

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Factors Influencing Retention in HIV Treatment Programs in Sub-Saharan Africa

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

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. Patient accounting

  10. Selected characteristics at baseline (ART initiation)

  11. Selected program characteristics (1)

  12. Program characteristics (2)

  13. Levels of retention

  14. Model building - risk factors for attrition

  15. Risk factors of attrition - Multivariable analysis (1)

  16. Risk factors of attrition - Multivariable analysis (2)

  17. Risk factors of attrition - Multivariable analysis (3)

  18. Lower retention amongst men in programs without community dispensing but similar in programs with ARV dispensing More difficultfor men tocometoclinicfor drug pick-up?

  19. 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

  20. Special thanks to our funders and partners:

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

  22. Extra-Correction for sampling

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