Retention and predictors of attrition among patients who started antiretroviral therapy in Zimbabwe’s national antiretroviral therapy programme between 2012 and 2015


Autoři: Richard Makurumidze aff001;  Tsitsi Mutasa-Apollo aff004;  Tom Decroo aff002;  Regis C. Choto aff004;  Kudakwashe C. Takarinda aff004;  Janet Dzangare aff004;  Lutgarde Lynen aff002;  Wim Van Damme aff002;  James Hakim aff001;  Tapuwa Magure aff007;  Owen Mugurungi aff004;  Simbarashe Rusakaniko aff001
Působiště autorů: College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe aff001;  Institute of Tropical Medicine, Antwerp, Belgium aff002;  Gerontology, Faculty of Medicine & Pharmacy, Free University of Brussels (VUB), Brussels, Belgium aff003;  AIDS & TB Unit, Ministry of Health & Child Care, Harare, Zimbabwe aff004;  Research Foundation of Flanders, Brussels, Belgium aff005;  International Union Against Tuberculosis and Lung Disease, Paris, France aff006;  National AIDS Council, Harare, Zimbabwe aff007
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222309

Souhrn

Background

The last evaluation to assess outcomes for patients receiving antiretroviral therapy (ART) through the Zimbabwe public sector was conducted in 2011, covering the 2007–2010 cohorts. The reported retention at 6, 12, 24 and 36 months were 90.7%, 78.1%, 68.8% and 64.4%, respectively. We report findings of a follow-up evaluation for the 2012–2015 cohorts to assess the implementation and impact of recommendations from this prior evaluation.

Methods

A nationwide retrospective study was conducted in 2016. Multi-stage proportional sampling was used to select health facilities and study participants records. The data extracted from patient manual records included demographic, baseline clinical characteristics and patient outcomes (active on treatment, died, transferred out, stopped ART and lost to follow-up (LTFU)) at 6, 12, 24 and 36 months. The data were analysed using Stata/IC 14.2. Retention was estimated using survival analysis. The predictors associated with attrition were determined using a multivariate Cox regression model.

Results

A total of 3,810 participants were recruited in the study. The median age in years was 35 (IQR: 28–42). Overall, retention increased to 92.4% (p-value = 0.060), 86.5% (p-value<0.001), 79.2% (p-value<0.001) and 74.4% (p-value<0.001) at 6, 12, 24 and 36 months respectively. LTFU accounted for 98% of attrition. Being an adolescent or a young adult (15–24 years) (vs adult;1.41; 95% CI:1.14–1.74), children (<15years) (vs adults; aHR 0.64; 95% CI:0.46–0.91), receiving care at primary health care facility (vs central and provincial facility; aHR 1.23; 95% CI:1.01–1.49), having initiated ART between 2014–2015 (vs 2012–2013; aHR1.45; 95%CI:1.24–1.69), having WHO Stage IV (vs Stage I-III; aHR2.06; 95%CI:1.51–2.81) and impaired functional status (vs normal status; aHR1.25; 95%CI:1.04–1.49) predicted attrition.

Conclusion

The overall retention was higher in comparison to the previous 2007–2010 evaluation. Further studies to understand why attrition was found to be higher at primary health care facilities are warranted. Implementation of strategies for managing patients with advanced HIV disease, differentiated care for adolescents and young adults and tracking of LTFU clients should be prioritised to further improve retention.

Klíčová slova:

Adolescents – Antiretroviral therapy – Health care facilities – HIV – HIV diagnosis and management – Pregnancy – Young adults – Zimbabwe


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