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Facility-Level Factors Influencing Retention of Patients in HIV Care in East Africa
- Source :
- PloS one, vol 11, iss 8, PLoS ONE, Vol 11, Iss 8, p e0159994 (2016), PLoS ONE
- Publication Year :
- 2016
- Publisher :
- eScholarship, University of California, 2016.
-
Abstract
- Losses to follow-up (LTFU) remain an important programmatic challenge. While numerous patient-level factors have been associated with LTFU, less is known about facility-level factors. Data from the East African International epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium was used to identify facility-level factors associated with LTFU in Kenya, Tanzania and Uganda. Patients were defined as LTFU if they had no visit within 12 months of the study endpoint for pre-ART patients or 6 months for patients on ART. Adjusting for patient factors, shared frailty proportional hazard models were used to identify the facility-level factors associated with LTFU for the pre- and post-ART periods. Data from 77,362 patients and 29 facilities were analyzed. Median age at enrolment was 36.0 years (Interquartile Range: 30.1, 43.1), 63.9% were women and 58.3% initiated ART. Rates (95% Confidence Interval) of LTFU were 25.1 (24.7-25.6) and 16.7 (16.3-17.2) per 100 person-years in the pre-ART and post-ART periods, respectively. Facility-level factors associated with increased LTFU included secondary-level care, HIV RNA PCR turnaround time >14 days, and no onsite availability of CD4 testing. Increased LTFU was also observed when no nutritional supplements were provided (pre-ART only), when TB patients were treated within the HIV program (pre-ART only), and when the facility was open ≤4 mornings per week (ART only). Our findings suggest that facility-based strategies such as point of care laboratory testing and separate clinic spaces for TB patients may improve retention.
- Subjects :
- RNA viruses
Bacterial Diseases
Male
Pediatrics
Databases, Factual
Epidemiology
Human immunodeficiency virus (HIV)
lcsh:Medicine
HIV Infections
Kaplan-Meier Estimate
Pathology and Laboratory Medicine
medicine.disease_cause
Tanzania
Geographical Locations
0302 clinical medicine
Immunodeficiency Viruses
Interquartile range
Medicine and Health Sciences
Public and Occupational Health
Uganda
030212 general & internal medicine
Viral
lcsh:Science
Multidisciplinary
biology
Reverse Transcriptase Polymerase Chain Reaction
HIV diagnosis and management
Vaccination and Immunization
3. Good health
Infectious Diseases
Medical Microbiology
HIV epidemiology
Viral Pathogens
Viruses
HIV/AIDS
RNA, Viral
Female
Pathogens
Infection
Research Article
Adult
medicine.medical_specialty
Tuberculosis
Anti-HIV Agents
General Science & Technology
Immunology
030231 tropical medicine
Antiretroviral Therapy
Microbiology
03 medical and health sciences
Databases
Antiviral Therapy
Acquired immunodeficiency syndrome (AIDS)
Clinical Research
Retroviruses
medicine
Humans
Lost to follow-up
Microbial Pathogens
Factual
Proportional Hazards Models
business.industry
Proportional hazards model
Lentivirus
lcsh:R
Organisms
Biology and Life Sciences
HIV
Tropical Diseases
medicine.disease
biology.organism_classification
Kenya
Diagnostic medicine
Confidence interval
CD4 Lymphocyte Count
People and Places
Africa
RNA
lcsh:Q
Lost to Follow-Up
Preventive Medicine
Health Facilities
business
Delivery of Health Care
Demography
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- PloS one, vol 11, iss 8, PLoS ONE, Vol 11, Iss 8, p e0159994 (2016), PLoS ONE
- Accession number :
- edsair.doi.dedup.....095382138461236f366a3e58213a4b20