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

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

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

January 2016
By Farahani, Mansour ; Price, Natalie ; El-Halabi, Shenaaz ; ...
Source: Trop Med Int Health. 2016 Jan;21(1):18-27
Series: PEPFAR

English

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Farahani, Mansour ; Price, Natalie ; El-Halabi, Shenaaz ; Mlaudzi, Naledi ; Keapoletswe, Koona ; ... More +

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 Less -
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 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.
Subjects:

[+]

Acquired Immunodeficiency Syndrome/therapy
Source:

Trop Med Int Health. 2016 Jan;21(1):18-27
Series:

PEPFAR
Pubmed ID:

26485172
Pubmed Central ID:

PMC4834839
Document Type:

Journal Article
Funding:

CC999999/Intramural CDC HHS/United States
Place as Subject:

Botswana
Collection(s):

CDC Public Access
Main Document Checksum:

[+]

urn:sha256:431359b43b332e15da3880937035a3421de1f358222f8616f41b3d56778f9f9d
Download URL:

https://stacks.cdc.gov/view/cdc/44650/cdc_44650_DS1.pdf
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[PDF-367.07 KB]