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Association of adherence support and outreach services with total attrition, loss to follow-up, and death among ART patients in sub-Saharan Africa.

Lamb MR, El-Sadr WM, Geng E, Nash D - PLoS ONE (2012)

Bottom Line: Clinics with availability of counseling services (RR(adj)=0.62, 95%CI: 0.42-0.92), educational materials (RR(adj)=0.73, 95%CI: 0.63-0.85), reminder tools (RR(adj)=0.79, 95%CI: 0.64-0.97), and food rations (RR(adj)=0.72, 95%CI: 0.58-0.90) had significantly lower attrition, with similar results observed for LTF.Availability of food rations was marginally associated with increased retention at 6 (RR(adj,6m) =0.82, 95%CI: 0.64-1.05) but not 12 months (RR(adj,12m) =0.98, 95%CI: 0.78-1.21).Availability of adherence support services, active patient outreach and food rations at HIV care clinics may improve retention following ART initiation.

View Article: PubMed Central - PubMed

Affiliation: International Center for AIDS Care and Treatment Programs (ICAP), Mailman School of Public Health, Columbia University, New York, New York, United States of America. mrl2013@columbia.edu

ABSTRACT

Background: Loss to follow-up (LTF) after antiretroviral therapy (ART) initiation is common in HIV clinics. We examined the effect of availability of adherence support and active patient outreach services on patient attrition following ART initiation.

Methods and findings: This ecologic study examined clinic attrition rates (total attrition, LTF, and death) among 232,389 patients initiating ART at 349 clinics during 2004-2008 in 10 sub-Saharan African countries, and cohort attrition (proportion retained at 6 and 12 months after ART initiation) among a subset of patients with follow-up information (n=83,389). Log-linear regression compared mean rates of attrition, LTF, and death between clinics with and without adherence support and outreach services. Cumulative attrition, LTF, and death rates were 14.2, 9.2, and 4.9 per 100 person-years on ART, respectively. In multivariate analyses, clinic availability of >2 adherence support services was marginally associated with lower attrition rates (RR(adj)=0.59, 95%CI: 0.35-1.0). Clinics with availability of counseling services (RR(adj)=0.62, 95%CI: 0.42-0.92), educational materials (RR(adj)=0.73, 95%CI: 0.63-0.85), reminder tools (RR(adj)=0.79, 95%CI: 0.64-0.97), and food rations (RR(adj)=0.72, 95%CI: 0.58-0.90) had significantly lower attrition, with similar results observed for LTF. Outreach services were not significantly associated with attrition. In cohort analyses, attrition was significantly lower at clinics offering >2 adherence support services (RR(adj,6m)=0.84, 95%CI: 0.73-0.96), dedicated pharmacy services (RR(adj,6m)=0.78, 95%CI: 0.69-0.90), and active patient outreach (RR(adj,6m)=0.85, 95%CI: 0.73-0.99). Availability of food rations was marginally associated with increased retention at 6 (RR(adj,6m) =0.82, 95%CI: 0.64-1.05) but not 12 months (RR(adj,12m) =0.98, 95%CI: 0.78-1.21).

Conclusions: Availability of adherence support services, active patient outreach and food rations at HIV care clinics may improve retention following ART initiation.

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Related in: MedlinePlus

Schematic calculation of clinic-level attrition, LTF, and death rates using aggregate data.Ni  =  Number of patients active on ART at the end of reporting quarter i. Newi  =  Number of patients newly initiating ART during reporting quarter i. Atti  =  Number of patients attritioned (discontinued ART, lost to follow-up, or dead) during quarter i. Ti  =  Number of patients transferring to another clinic during quarter i.
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pone-0038443-g001: Schematic calculation of clinic-level attrition, LTF, and death rates using aggregate data.Ni  =  Number of patients active on ART at the end of reporting quarter i. Newi  =  Number of patients newly initiating ART during reporting quarter i. Atti  =  Number of patients attritioned (discontinued ART, lost to follow-up, or dead) during quarter i. Ti  =  Number of patients transferring to another clinic during quarter i.

Mentions: Clinic person-time on ART during each quarter was calculated by allotting 3 months of person-time for each patient on ART at the beginning of a given quarter, and 1.5 months for patients initiating ART or discontinuing ART (death, transfer, LTF, stopping ART) during the quarter. Thus, all attrition and ART initiation was assumed to occur at the middle of each quarter. These person-months were summed across all quarters through December 2008 to obtain cumulative clinic person-time on ART. Total attrition, death, and LTF rates were computed by dividing the cumulative number of attritions, deaths, or LTF, respectively, by the cumulative clinic person-time on ART for each clinic. Rates through December 2008 were expressed per 100 person-years on ART. Figure 1 describes the method used to calculate clinic-level attrition, LTF, and death rates using the example of total attrition.


Association of adherence support and outreach services with total attrition, loss to follow-up, and death among ART patients in sub-Saharan Africa.

Lamb MR, El-Sadr WM, Geng E, Nash D - PLoS ONE (2012)

Schematic calculation of clinic-level attrition, LTF, and death rates using aggregate data.Ni  =  Number of patients active on ART at the end of reporting quarter i. Newi  =  Number of patients newly initiating ART during reporting quarter i. Atti  =  Number of patients attritioned (discontinued ART, lost to follow-up, or dead) during quarter i. Ti  =  Number of patients transferring to another clinic during quarter i.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3369888&req=5

pone-0038443-g001: Schematic calculation of clinic-level attrition, LTF, and death rates using aggregate data.Ni  =  Number of patients active on ART at the end of reporting quarter i. Newi  =  Number of patients newly initiating ART during reporting quarter i. Atti  =  Number of patients attritioned (discontinued ART, lost to follow-up, or dead) during quarter i. Ti  =  Number of patients transferring to another clinic during quarter i.
Mentions: Clinic person-time on ART during each quarter was calculated by allotting 3 months of person-time for each patient on ART at the beginning of a given quarter, and 1.5 months for patients initiating ART or discontinuing ART (death, transfer, LTF, stopping ART) during the quarter. Thus, all attrition and ART initiation was assumed to occur at the middle of each quarter. These person-months were summed across all quarters through December 2008 to obtain cumulative clinic person-time on ART. Total attrition, death, and LTF rates were computed by dividing the cumulative number of attritions, deaths, or LTF, respectively, by the cumulative clinic person-time on ART for each clinic. Rates through December 2008 were expressed per 100 person-years on ART. Figure 1 describes the method used to calculate clinic-level attrition, LTF, and death rates using the example of total attrition.

Bottom Line: Clinics with availability of counseling services (RR(adj)=0.62, 95%CI: 0.42-0.92), educational materials (RR(adj)=0.73, 95%CI: 0.63-0.85), reminder tools (RR(adj)=0.79, 95%CI: 0.64-0.97), and food rations (RR(adj)=0.72, 95%CI: 0.58-0.90) had significantly lower attrition, with similar results observed for LTF.Availability of food rations was marginally associated with increased retention at 6 (RR(adj,6m) =0.82, 95%CI: 0.64-1.05) but not 12 months (RR(adj,12m) =0.98, 95%CI: 0.78-1.21).Availability of adherence support services, active patient outreach and food rations at HIV care clinics may improve retention following ART initiation.

View Article: PubMed Central - PubMed

Affiliation: International Center for AIDS Care and Treatment Programs (ICAP), Mailman School of Public Health, Columbia University, New York, New York, United States of America. mrl2013@columbia.edu

ABSTRACT

Background: Loss to follow-up (LTF) after antiretroviral therapy (ART) initiation is common in HIV clinics. We examined the effect of availability of adherence support and active patient outreach services on patient attrition following ART initiation.

Methods and findings: This ecologic study examined clinic attrition rates (total attrition, LTF, and death) among 232,389 patients initiating ART at 349 clinics during 2004-2008 in 10 sub-Saharan African countries, and cohort attrition (proportion retained at 6 and 12 months after ART initiation) among a subset of patients with follow-up information (n=83,389). Log-linear regression compared mean rates of attrition, LTF, and death between clinics with and without adherence support and outreach services. Cumulative attrition, LTF, and death rates were 14.2, 9.2, and 4.9 per 100 person-years on ART, respectively. In multivariate analyses, clinic availability of >2 adherence support services was marginally associated with lower attrition rates (RR(adj)=0.59, 95%CI: 0.35-1.0). Clinics with availability of counseling services (RR(adj)=0.62, 95%CI: 0.42-0.92), educational materials (RR(adj)=0.73, 95%CI: 0.63-0.85), reminder tools (RR(adj)=0.79, 95%CI: 0.64-0.97), and food rations (RR(adj)=0.72, 95%CI: 0.58-0.90) had significantly lower attrition, with similar results observed for LTF. Outreach services were not significantly associated with attrition. In cohort analyses, attrition was significantly lower at clinics offering >2 adherence support services (RR(adj,6m)=0.84, 95%CI: 0.73-0.96), dedicated pharmacy services (RR(adj,6m)=0.78, 95%CI: 0.69-0.90), and active patient outreach (RR(adj,6m)=0.85, 95%CI: 0.73-0.99). Availability of food rations was marginally associated with increased retention at 6 (RR(adj,6m) =0.82, 95%CI: 0.64-1.05) but not 12 months (RR(adj,12m) =0.98, 95%CI: 0.78-1.21).

Conclusions: Availability of adherence support services, active patient outreach and food rations at HIV care clinics may improve retention following ART initiation.

Show MeSH
Related in: MedlinePlus