Retention and risk factors for attrition among adults in antiretroviral treatment programmes in Tanzania, Uganda and Zambia

Olivier Koole, Sharon Tsui, Fred Wabwire-Mangen, Gideon Kwesigabo, Joris Menten, Modest Mulenga, Andrew Auld, Simon Agolory, Ya Diul Mukadi, Robert Colebunders, David Bangsberg, Eric van Praag, Kwasi Torpey, Seymour Williams, Jonathan Kaplan, Aaron Zee, Julie Denison

Research output: Contribution to journalArticle

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Abstract

Objectives: We assessed retention and predictors of attrition (recorded death or loss to follow-up) in antiretroviral treatment (ART) clinics in Tanzania, Uganda and Zambia. Methods: We conducted a retrospective cohort study among adults (≥18 years) starting ART during 2003–2010. We purposefully selected six health facilities per country and randomly selected 250 patients from each facility. Patients who visited clinics at least once during the 90 days before data abstraction were defined as retained. Data on individual and programme level risk factors for attrition were obtained through chart review and clinic manager interviews. Kaplan–Meier curves for retention across sites were created. Predictors of attrition were assessed using a multivariable Cox-proportional hazards model, adjusted for site-level clustering. Results: From 17 facilities, 4147 patients were included. Retention ranged from 52.0% to 96.2% at 1 year to 25.8%–90.4% at 4 years. Multivariable analysis of ART initiation characteristics found the following independent risk factors for attrition: younger age [adjusted hazard ratio (aHR) and 95% confidence interval (95%CI) = 1.30 (1.14–1.47)], WHO stage 4 ([aHR (95% CI): 1.56 (1.29–1.88)], >10% bodyweight loss [aHR (95%CI) = 1.17 (1.00–1.38)], poor functional status [ambulatory aHR (95%CI) = 1.29 (1.09–1.54); bedridden aHR1.54 (1.15–2.07)], and increasing years of clinic operation prior to ART initiation in government facilities [aHR (95%CI) = 1.17 (1.10–1.23)]. Patients with higher CD4 cell count were less likely to experience attrition [aHR (95%CI) = 0.88 (0.78–1.00)] for every log (tenfold) increase. Sites offering community ART dispensing [aHR (95%CI) = 0.55 (0.30–1.01) for women; 0.40 (0.21–0.75) for men] had significantly less attrition. Conclusions: Patient retention to an individual programme worsened over time especially among males, younger persons and those with poor clinical indicators. Community ART drug dispensing programmes could improve retention.

Original languageEnglish (US)
Pages (from-to)1397-1410
Number of pages14
JournalTropical Medicine and International Health
Volume19
Issue number12
DOIs
StatePublished - Dec 1 2014
Externally publishedYes

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Zambia
Uganda
Tanzania
Confidence Intervals
Therapeutics
Health Facilities
CD4 Lymphocyte Count
Proportional Hazards Models
Cluster Analysis
Cohort Studies
Retrospective Studies
Interviews
Pharmaceutical Preparations

Keywords

  • ART
  • HIV
  • retention
  • sub-Saharan Africa

ASJC Scopus subject areas

  • Parasitology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

Retention and risk factors for attrition among adults in antiretroviral treatment programmes in Tanzania, Uganda and Zambia. / Koole, Olivier; Tsui, Sharon; Wabwire-Mangen, Fred; Kwesigabo, Gideon; Menten, Joris; Mulenga, Modest; Auld, Andrew; Agolory, Simon; Mukadi, Ya Diul; Colebunders, Robert; Bangsberg, David; van Praag, Eric; Torpey, Kwasi; Williams, Seymour; Kaplan, Jonathan; Zee, Aaron; Denison, Julie.

In: Tropical Medicine and International Health, Vol. 19, No. 12, 01.12.2014, p. 1397-1410.

Research output: Contribution to journalArticle

Koole, O, Tsui, S, Wabwire-Mangen, F, Kwesigabo, G, Menten, J, Mulenga, M, Auld, A, Agolory, S, Mukadi, YD, Colebunders, R, Bangsberg, D, van Praag, E, Torpey, K, Williams, S, Kaplan, J, Zee, A & Denison, J 2014, 'Retention and risk factors for attrition among adults in antiretroviral treatment programmes in Tanzania, Uganda and Zambia', Tropical Medicine and International Health, vol. 19, no. 12, pp. 1397-1410. https://doi.org/10.1111/tmi.12386
Koole, Olivier ; Tsui, Sharon ; Wabwire-Mangen, Fred ; Kwesigabo, Gideon ; Menten, Joris ; Mulenga, Modest ; Auld, Andrew ; Agolory, Simon ; Mukadi, Ya Diul ; Colebunders, Robert ; Bangsberg, David ; van Praag, Eric ; Torpey, Kwasi ; Williams, Seymour ; Kaplan, Jonathan ; Zee, Aaron ; Denison, Julie. / Retention and risk factors for attrition among adults in antiretroviral treatment programmes in Tanzania, Uganda and Zambia. In: Tropical Medicine and International Health. 2014 ; Vol. 19, No. 12. pp. 1397-1410.
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abstract = "Objectives: We assessed retention and predictors of attrition (recorded death or loss to follow-up) in antiretroviral treatment (ART) clinics in Tanzania, Uganda and Zambia. Methods: We conducted a retrospective cohort study among adults (≥18 years) starting ART during 2003–2010. We purposefully selected six health facilities per country and randomly selected 250 patients from each facility. Patients who visited clinics at least once during the 90 days before data abstraction were defined as retained. Data on individual and programme level risk factors for attrition were obtained through chart review and clinic manager interviews. Kaplan–Meier curves for retention across sites were created. Predictors of attrition were assessed using a multivariable Cox-proportional hazards model, adjusted for site-level clustering. Results: From 17 facilities, 4147 patients were included. Retention ranged from 52.0{\%} to 96.2{\%} at 1 year to 25.8{\%}–90.4{\%} at 4 years. Multivariable analysis of ART initiation characteristics found the following independent risk factors for attrition: younger age [adjusted hazard ratio (aHR) and 95{\%} confidence interval (95{\%}CI) = 1.30 (1.14–1.47)], WHO stage 4 ([aHR (95{\%} CI): 1.56 (1.29–1.88)], >10{\%} bodyweight loss [aHR (95{\%}CI) = 1.17 (1.00–1.38)], poor functional status [ambulatory aHR (95{\%}CI) = 1.29 (1.09–1.54); bedridden aHR1.54 (1.15–2.07)], and increasing years of clinic operation prior to ART initiation in government facilities [aHR (95{\%}CI) = 1.17 (1.10–1.23)]. Patients with higher CD4 cell count were less likely to experience attrition [aHR (95{\%}CI) = 0.88 (0.78–1.00)] for every log (tenfold) increase. Sites offering community ART dispensing [aHR (95{\%}CI) = 0.55 (0.30–1.01) for women; 0.40 (0.21–0.75) for men] had significantly less attrition. Conclusions: Patient retention to an individual programme worsened over time especially among males, younger persons and those with poor clinical indicators. Community ART drug dispensing programmes could improve retention.",
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T1 - Retention and risk factors for attrition among adults in antiretroviral treatment programmes in Tanzania, Uganda and Zambia

AU - Koole, Olivier

AU - Tsui, Sharon

AU - Wabwire-Mangen, Fred

AU - Kwesigabo, Gideon

AU - Menten, Joris

AU - Mulenga, Modest

AU - Auld, Andrew

AU - Agolory, Simon

AU - Mukadi, Ya Diul

AU - Colebunders, Robert

AU - Bangsberg, David

AU - van Praag, Eric

AU - Torpey, Kwasi

AU - Williams, Seymour

AU - Kaplan, Jonathan

AU - Zee, Aaron

AU - Denison, Julie

PY - 2014/12/1

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N2 - Objectives: We assessed retention and predictors of attrition (recorded death or loss to follow-up) in antiretroviral treatment (ART) clinics in Tanzania, Uganda and Zambia. Methods: We conducted a retrospective cohort study among adults (≥18 years) starting ART during 2003–2010. We purposefully selected six health facilities per country and randomly selected 250 patients from each facility. Patients who visited clinics at least once during the 90 days before data abstraction were defined as retained. Data on individual and programme level risk factors for attrition were obtained through chart review and clinic manager interviews. Kaplan–Meier curves for retention across sites were created. Predictors of attrition were assessed using a multivariable Cox-proportional hazards model, adjusted for site-level clustering. Results: From 17 facilities, 4147 patients were included. Retention ranged from 52.0% to 96.2% at 1 year to 25.8%–90.4% at 4 years. Multivariable analysis of ART initiation characteristics found the following independent risk factors for attrition: younger age [adjusted hazard ratio (aHR) and 95% confidence interval (95%CI) = 1.30 (1.14–1.47)], WHO stage 4 ([aHR (95% CI): 1.56 (1.29–1.88)], >10% bodyweight loss [aHR (95%CI) = 1.17 (1.00–1.38)], poor functional status [ambulatory aHR (95%CI) = 1.29 (1.09–1.54); bedridden aHR1.54 (1.15–2.07)], and increasing years of clinic operation prior to ART initiation in government facilities [aHR (95%CI) = 1.17 (1.10–1.23)]. Patients with higher CD4 cell count were less likely to experience attrition [aHR (95%CI) = 0.88 (0.78–1.00)] for every log (tenfold) increase. Sites offering community ART dispensing [aHR (95%CI) = 0.55 (0.30–1.01) for women; 0.40 (0.21–0.75) for men] had significantly less attrition. Conclusions: Patient retention to an individual programme worsened over time especially among males, younger persons and those with poor clinical indicators. Community ART drug dispensing programmes could improve retention.

AB - Objectives: We assessed retention and predictors of attrition (recorded death or loss to follow-up) in antiretroviral treatment (ART) clinics in Tanzania, Uganda and Zambia. Methods: We conducted a retrospective cohort study among adults (≥18 years) starting ART during 2003–2010. We purposefully selected six health facilities per country and randomly selected 250 patients from each facility. Patients who visited clinics at least once during the 90 days before data abstraction were defined as retained. Data on individual and programme level risk factors for attrition were obtained through chart review and clinic manager interviews. Kaplan–Meier curves for retention across sites were created. Predictors of attrition were assessed using a multivariable Cox-proportional hazards model, adjusted for site-level clustering. Results: From 17 facilities, 4147 patients were included. Retention ranged from 52.0% to 96.2% at 1 year to 25.8%–90.4% at 4 years. Multivariable analysis of ART initiation characteristics found the following independent risk factors for attrition: younger age [adjusted hazard ratio (aHR) and 95% confidence interval (95%CI) = 1.30 (1.14–1.47)], WHO stage 4 ([aHR (95% CI): 1.56 (1.29–1.88)], >10% bodyweight loss [aHR (95%CI) = 1.17 (1.00–1.38)], poor functional status [ambulatory aHR (95%CI) = 1.29 (1.09–1.54); bedridden aHR1.54 (1.15–2.07)], and increasing years of clinic operation prior to ART initiation in government facilities [aHR (95%CI) = 1.17 (1.10–1.23)]. Patients with higher CD4 cell count were less likely to experience attrition [aHR (95%CI) = 0.88 (0.78–1.00)] for every log (tenfold) increase. Sites offering community ART dispensing [aHR (95%CI) = 0.55 (0.30–1.01) for women; 0.40 (0.21–0.75) for men] had significantly less attrition. Conclusions: Patient retention to an individual programme worsened over time especially among males, younger persons and those with poor clinical indicators. Community ART drug dispensing programmes could improve retention.

KW - ART

KW - HIV

KW - retention

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