Variation in attrition at sub-national level: Review of the Botswana National HIV/AIDS Treatment (Masa) program data (2002–2013)

Details

• Alternative Title:
  Trop Med Int Health
• Personal Author:
  Farahani, Mansour ; Price, Natalie ; El-Halabi, Shenaaz ; Mlaudzi, Naledi ; Keapoletswe, Koona ; Lebelonyane, Refeletswe ; Fetogang, Ernest Benny ; Chebani, Tony ; Kebaabetswe, Poloko ; Masupe, Tiny ; Gabaake, Keba ; Auld, Andrew ; Nkomazana, Oathokwa ; Marlink, Richard
• Description:
  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, 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.
  
  
• Keywords:
  ART Attrition Botswana HIV Marginal Structural Model Multilevel
• Source:
  Trop Med Int Health. 21(1):18-27
• Pubmed ID:
  26485172
• Pubmed Central ID:
  PMC4834839
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHSUnited States/
• Volume:
  21
• Issue:
  1
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:431359b43b332e15da3880937035a3421de1f358222f8616f41b3d56778f9f9d
• Download URL:
  https://stacks.cdc.gov/view/cdc/38970/cdc_38970_DS1.pdf
• File Type:
  [PDF - 367.07 KB ]