Validity of reported retention in antiretroviral therapy after roll-out to peripheral facilities in Mozambique: Results of a retrospective national cohort analysis

• DOI: 10.1371/journal.pone.0198916
• Publication Date: 2018-06-21T13:43:32Z
• Authors: Yves Lafort; Aleny Couto; Ute Sunderbrink; Roxanne Hoek; Estifanos Shargie; Jinkou Zhao; Kirsi Viisainen; Bertha Simwaka
• Keywords: COUNTRIES; Adult; Male; Adolescent; Anti-HIV Agents; Science; HIV Infections; Medication Adherence; Cohort Studies; 03 medical and health sciences; 0302 clinical medicine; PROGRAMS; PATIENT RETENTION; Pregnancy; Medicine and Health Sciences; Humans; SUB-SAHARAN AFRICA; Child; Mozambique; Retrospective Studies; INCOME; Q; R; Infant, Newborn; Infant; HIV CARE; Middle Aged; TRENDS; CD4 Lymphocyte Count; 3. Good health; Anti-Retroviral Agents; Child, Preschool; RISK-FACTORS; SURVIVAL; Medicine; Female; Lost to Follow-Up; Research Article

Background Retention in anti-retroviral therapy (ART) presents a challenge sub-Saharan Africa. In Mozambique, after roll-out to peripheral facilities, the 12-month retention rate was reported mostly from sites with an electronic patient tracking system (EPTS), representing only 65% of patients. We conducted nationally representative study, compared at EPTS and non-EPTS sites, its predictors. Methods Applying proportionate population size sampling strategy, we obtained sample patients who initiated ART between January 2013 June 2014. calculated weighted proportions patients' status 12 months initiation, incidence lost follow-up (LTFU) death. assessed determinants LTFU death by calculating adjusted hazard ratios (AHR) through multivariate cox-proportional models. Results Among 19,297 sampled, 54.3% were still active, 33.1% LTFU, 2.0% dead, 2.6% transferred-out 8.0% had unknown status, initiation. Total attrition (LTFU or dead) 45.5/100PY, higher facilities without (51.8/100PY) than (37.7/100PY). Clinical stage IV (AHR = 1.7), CD4 count ≤150 1.3) being pregnant 1.6) significantly associated LTFU. III 2.1 3.8), 3.0), not regimens stavudine 4.28) deaths. Patients enrolled adherence support groups 4.6 times less likely be but number (n 174) too small significant (p 0.273). Conclusion substantially lower sites. should expanded all facilitate comprehensive routine monitoring care. Mozambique is low needs improved, especially among women advanced disease The effect further monitored.