Olivier Koole1,2, Rein Mgj Houben3, Themba Mzembe2, Thomas P Van Boeckel4,5, Michael Kayange6, Andreas Jahn7,8, Frank Chimbwandira7, Judith R Glynn1, Amelia C Crampin1,2. 1. Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK. 2. Karonga Prevention Study, Chilumba, Malawi. 3. TB Modelling Group, TB Centre, Department of Epidemiology and Public Health, London School of Hygiene and Tropical Medicine, London, UK. 4. Ecology and Evolutionary Biology Department, Princeton University, Princeton, NJ, USA. 5. Princeton Environmental Institute, Princeton, NJ, USA. 6. Ministry of Health, Karonga, Malawi. 7. Ministry of Health - HIV/AIDS unit, Lilongwe, Malawi. 8. International Training and Education Center for Health, University of Washington, Seattle, USA.
Abstract
BACKGROUND: Patient retention in antiretroviral therapy (ART) programs remains a major challenge in sub-Saharan Africa. We examined whether and why retention in ART care has changed with increasing access. METHODS: Retrospective cohort study combining individual data from ART registers and interview data, enabling us to link patients across different ART clinics in Karonga District, Malawi. We recorded information on all adults (≥15 years) starting ART between July 2005 and August 2012, including those initiating due to pregnancy and breastfeeding (Option B+). Retention in care was defined as being alive and receiving ART at the end of study. Predictors of attrition were assessed using a multivariable Cox proportional hazards model. RESULTS: The number of clinics providing ART increased from 1 in 2005 to 16 in 2012. Six-month retention increased from 73% [95% confidence interval (CI): 71 to 76] to 93% (95% CI: 92 to 94) when comparing the 2005-2006 and 2011-2012 cohorts, and 12-month retention increased from 70% (95% CI: 67 to 73) to 92% (95% CI: 90 to 93). Over the study period, the proportion of patients starting ART at World Health Organization stage 4 declined from 62% to 10%. Being a man, younger than 35 years, having a more advanced World Health Organization stage and being part of an earlier cohort were all independently associated with attrition. Women starting ART for Option B+ experienced higher attrition than women of childbearing age starting for other reasons. CONCLUSIONS: In this area, retention in care has increased dramatically. Improved health in patients starting ART and decentralization of ART care to peripheral health centers seem to be the major drivers for this change.
BACKGROUND:Patient retention in antiretroviral therapy (ART) programs remains a major challenge in sub-Saharan Africa. We examined whether and why retention in ART care has changed with increasing access. METHODS: Retrospective cohort study combining individual data from ART registers and interview data, enabling us to link patients across different ART clinics in Karonga District, Malawi. We recorded information on all adults (≥15 years) starting ART between July 2005 and August 2012, including those initiating due to pregnancy and breastfeeding (Option B+). Retention in care was defined as being alive and receiving ART at the end of study. Predictors of attrition were assessed using a multivariable Cox proportional hazards model. RESULTS: The number of clinics providing ART increased from 1 in 2005 to 16 in 2012. Six-month retention increased from 73% [95% confidence interval (CI): 71 to 76] to 93% (95% CI: 92 to 94) when comparing the 2005-2006 and 2011-2012 cohorts, and 12-month retention increased from 70% (95% CI: 67 to 73) to 92% (95% CI: 90 to 93). Over the study period, the proportion of patients starting ART at World Health Organization stage 4 declined from 62% to 10%. Being a man, younger than 35 years, having a more advanced World Health Organization stage and being part of an earlier cohort were all independently associated with attrition. Women starting ART for Option B+ experienced higher attrition than women of childbearing age starting for other reasons. CONCLUSIONS: In this area, retention in care has increased dramatically. Improved health in patients starting ART and decentralization of ART care to peripheral health centers seem to be the major drivers for this change.
Authors: Joseph Kwong-Leung Yu; Solomon Chih-Cheng Chen; Kuo-Yang Wang; Chao-Sung Chang; Simon D Makombe; Erik J Schouten; Anthony D Harries Journal: Bull World Health Organ Date: 2007-07 Impact factor: 9.408
Authors: Charles F Gilks; Siobhan Crowley; René Ekpini; Sandy Gove; Jos Perriens; Yves Souteyrand; Don Sutherland; Marco Vitoria; Teguest Guerma; Kevin De Cock Journal: Lancet Date: 2006-08-05 Impact factor: 79.321
Authors: Adrienne K Chan; Gabriel Mateyu; Andreas Jahn; Erik Schouten; Paul Arora; William Mlotha; Marion Kambanji; Monique van Lettow Journal: Trop Med Int Health Date: 2010-06 Impact factor: 2.622
Authors: Thomas P Giordano; Allen L Gifford; A Clinton White; Maria E Suarez-Almazor; Linda Rabeneck; Christine Hartman; Lisa I Backus; Larry A Mole; Robert O Morgan Journal: Clin Infect Dis Date: 2007-04-23 Impact factor: 9.079
Authors: David W Lowrance; Simon Makombe; Anthony D Harries; Ray W Shiraishi; Mindy Hochgesang; John Aberle-Grasse; Edwin Libamba; Erik Schouten; Tedd Ellerbrock; Kelita Kamoto Journal: J Acquir Immune Defic Syndr Date: 2008-11-01 Impact factor: 3.731
Authors: David Coetzee; Katherine Hildebrand; Andrew Boulle; Gary Maartens; Francoise Louis; Veliswa Labatala; Hermann Reuter; Nonthutuzelo Ntwana; Eric Goemaere Journal: AIDS Date: 2004-04-09 Impact factor: 4.177
Authors: Brandon A Knettel; Cody Cichowitz; James Samwel Ngocho; Elizabeth T Knippler; Lilian N Chumba; Blandina T Mmbaga; Melissa H Watt Journal: J Acquir Immune Defic Syndr Date: 2018-04-15 Impact factor: 3.731
Authors: Andreas D Haas; Lyson Tenthani; Malango T Msukwa; Kali Tal; Andreas Jahn; Oliver J Gadabu; Adrian Spoerri; Frank Chimbwandira; Joep J van Oosterhout; Olivia Keiser Journal: Lancet HIV Date: 2016-03-09 Impact factor: 12.767
Authors: Jeremy Philip Brown; Bagrey Ngwira; Terence Tafatatha; Amelia Catharine Crampin; Neil French; Olivier Koole Journal: AIDS Res Ther Date: 2016-07-08 Impact factor: 2.250
Authors: Olivier Koole; Julie A Denison; Joris Menten; Sharon Tsui; Fred Wabwire-Mangen; Gideon Kwesigabo; Modest Mulenga; Andrew Auld; Simon Agolory; Ya Diul Mukadi; Eric van Praag; Kwasi Torpey; Seymour Williams; Jonathan Kaplan; Aaron Zee; David R Bangsberg; Robert Colebunders Journal: PLoS One Date: 2016-01-20 Impact factor: 3.240
Authors: Vivek Jain; Wei Chang; Dathan M Byonanebye; Asiphas Owaraganise; Ellon Twinomuhwezi; Gideon Amanyire; Douglas Black; Elliot Marseille; Moses R Kamya; Diane V Havlir; James G Kahn Journal: PLoS One Date: 2015-12-03 Impact factor: 3.240
Authors: Aisha N Z Dasgupta; Alison Wringe; Amelia C Crampin; Christina Chisambo; Olivier Koole; Simon Makombe; Charles Sungani; Jim Todd; Kathryn Church Journal: AIDS Care Date: 2016-04-21