Variation in attrition at subnational level: review of the Botswana National HIV/AIDS Treatment (Masa) programme data (2002-2013).

Autor: Farahani M; Harvard T.H. Chan School of Public Health, Boston, MA, USA., Price N; Harvard T.H. Chan School of Public Health, Boston, MA, USA., El-Halabi S; Ministry of Health, Gaborone, Botswana., Mlaudzi N; Ministry of Health, Gaborone, Botswana., Keapoletswe K; Ministry of Health, Gaborone, Botswana., Lebelonyane R; Ministry of Health, Gaborone, Botswana., Fetogang EB; Ministry of Health, Gaborone, Botswana., Chebani T; Ministry of Health, Gaborone, Botswana., Kebaabetswe P; University of Botswana, Gaborone, Botswana., Masupe T; University of Botswana, Gaborone, Botswana., Gabaake K; University of Botswana, Gaborone, Botswana., Auld A; Centers for Disease Control and Prevention, Atlanta, GA, USA., Nkomazana O; University of Botswana, Gaborone, Botswana., Marlink R; Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Jazyk: angličtina
Zdroj: Tropical medicine & international health : TM & IH [Trop Med Int Health] 2016 Jan; Vol. 21 (1), pp. 18-27. Date of Electronic Publication: 2015 Nov 12.
DOI: 10.1111/tmi.12623
Abstrakt: Objective: To evaluate the variation in all-cause attrition [mortality and loss to follow-up (LTFU)] among HIV-infected individuals in Botswana by health district during the rapid and massive scale-up of the National Treatment Program.
Methods: Analysis of routinely collected longitudinal data from 226 030 patients who received ART through the Botswana National HIV/AIDS Treatment Program across all 24 health districts from 2002 to 2013. A time-to-event analysis was used to measure crude mortality and loss to follow-up rates (LTFU). A marginal structural model was used to evaluate mortality and LTFU rates by district over time, adjusted for individual-level risk factors (e.g. age, gender, baseline CD4, year of treatment initiation and antiretroviral regimen).
Results: Mortality rates in the districts ranged from the lowest 1.0 (95% CI 0.9-1.1) in Selibe-Phikwe, to the highest 5.0 (95% CI 4.0-6.1), in Mabutsane. There was a wide range of overall LTFU across districts, including rates as low as 4.6 (95% CI 4.4-4.9) losses per 100 person-years in Ngamiland, and 5.9 (95% CI 5.6-6.2) losses per 100 person-years in South East district, to rates as high as 25.4 (95% CI 23.08-27.89) losses per 100 person-years in Mabutsane and 46.3 (95% CI 43.48-49.23) losses per 100 person-years in Okavango. Even when known risk factors for mortality and LTFU were adjusted for, district was a significant predictor of both mortality and LTFU rates.
Conclusion: We found statistically significant variation in attrition (mortality and LTFU) and data quality among districts. These findings suggest that district-level contextual factors affect retention in treatment. Further research needs to investigate factors that can potentially cause this variation.
(© 2015 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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