Details:

Alternative Title:
PLoS One
Publisher's site:
http://dx.doi.org/10.1371/journal.pone.0086305
Personal Author:
Mutasa-Apollo, Tsitsi ; Shiraishi, Ray W. ; Takarinda, Kudakwashe C. ; Dzangare, Janet ; Mugurungi, Owen ; ... More +
Mutasa-Apollo, Tsitsi ; Shiraishi, Ray W. ; Takarinda, Kudakwashe C. ; Dzangare, Janet ; Mugurungi, Owen ; Murungu, Joseph ; Abdul-Quader, Abu ; Woodfill, Celia J. I. Less -
Description:
Background

Since establishment of Zimbabwe's National Antiretroviral Therapy (ART) Programme in 2004, ART provision has expanded from <5,000 to 369,431 adults by 2011. However, patient outcomes are unexplored.

Objective

To determine improvement in health status, retention and factors associated with attrition among HIV-infected patients on ART.

Methods

A retrospective review of abstracted patient records of adults ≥15 years who initiated ART from 2007 to 2009 was done. Frequencies and medians were calculated for rates of retention in care and changes in key health status outcomes at 6, 12, 24 and 36 months respectively. Cox proportional hazards models were used to determine factors associated with attrition.

Results

Of the 3,919 patients, 64% were female, 86% were either WHO clinical stage III or IV. Rates of patient retention at 6, 12, 24 and 36 months were 90.7%, 78.1%, 68.8% and 64.4%, respectively. After ART initiation, median weight gains at 6, 12, and 24 months were 3, 4.5, and 5.0 kgs whilst median CD4+ cell count gains at 6, 12 and 24 months were 122, 157 and 279 cells/µL respectively. Factors associated with an increased risk of attrition included male gender (AHR 1.2; 95% CI, 1.1–1.4), baseline WHO stage IV (AHR 1.7; 95% CI, 1.1–2.6), lower baseline body weight (AHR 2.0; 95% CI, 1.4–2. 8) and accessing care from higher level healthcare facilities (AHR 3.5; 95% 1.1–11.2).

Conclusions

Our findings with regard to retention as well as clinical and immunological improvements following uptake of ART, are similar to what has been found in other settings. Factors influencing attrition also mirror those found in other parts of sub-Saharan Africa. These findings suggest the need to strengthen earlier diagnosis and treatment to further improve treatment outcomes. Whilst decentralisation improves ART coverage it should be coupled with strategies aimed at improving patient retention.


Subject:
[+]
Adult
Anti-HIV Agents
CD4 Lymphocyte Count
Female
HIV
HIV Infections
Humans
Male
Medication Adherence
Middle Aged
Patient Dropouts
Proportional Hazards Models
Retrospective Studies
Risk Factors
Treatment Outcome

Source:
PLoS One. 2014; 9(1).
Series:
PEPFAR
Pubmed ID:
24489714
Pubmed Central ID:
PMC3906052
Document Type:
Journal Article
Funding:
PEPFAR/United States
Place as Subject:
Zimbabwe
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:46909b019106332f2b0f392e4627f5fd0386dbc72f72c745ab15c367df65d4a9
File Type:

Supporting Files

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