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Patient attrition from the HIV antiretroviral therapy program at two hospitals in Haiti
  • Published Date:
    Oct 2014
  • Source:
    Rev Panam Salud Publica. 36(4):238-247.
Filetype[PDF - 564.29 KB]


Details:
  • Pubmed ID:
    25563149
  • Pubmed Central ID:
    PMC4745087
  • Funding:
    5U2GGH000549-03/PHS HHS/United States
    CC999999/Intramural CDC HHS/United States
    P30 AI027757/AI/NIAID NIH HHS/United States
    P30AI027757/AI/NIAID NIH HHS/United States
    U91HA0680/PEPFAR/United States
  • Document Type:
  • Collection(s):
  • Description:
    Objective

    To identify factors associated with antiretroviral therapy (ART) attrition among patients initiating therapy in 2005–2011 at two large, public-sector department-level hospitals, and to inform interventions to improve ART retention.

    Methods

    This retrospective cohort study used data from the iSanté electronic medical record (EMR) system. The study characterized ART attrition levels and explored the patient demographic, clinical, temporal, and service utilization factors associated with ART attrition, using time-to-event analysis methods.

    Results

    Among the 2 023 patients in the study, ART attrition on average was 17.0 per 100 person-years (95% confidence interval (CI): 15.8–18.3). In adjusted analyses, risk of ART attrition was up to 89% higher for patients living in distant communes compared to patients living in the same commune as the hospital (hazard ratio: 1.89, 95%CI: 1.54–2.33; P < 0.001). Hospital site, earlier year of ART start, spending less time enrolled in HIV care prior to ART initiation, receiving a non-standard ART regimen, lacking counseling prior to ART initiation, and having a higher body mass index were also associated with attrition risk.

    Conclusions

    The findings suggest quality improvement interventions at the two hospitals, including: enhanced retention support and transportation subsidies for patients accessing care from remote areas; counseling for all patients prior to ART initiation; timely outreach to patients who miss ART pick-ups; “bridging services” for patients transferring care to alternative facilities; routine screening for anticipated interruptions in future ART pick-ups; and medical case review for patients placed on non-standard ART regimens. The findings are also relevant for policymaking on decentralization of ART services in Haiti.