Retention and attrition during the preparation phase and after start of antiretroviral treatment in Thyolo, Malawi, and Kibera, Kenya: implications for programmes?

Hdl Handle:
http://hdl.handle.net/10144/143510
Title:
Retention and attrition during the preparation phase and after start of antiretroviral treatment in Thyolo, Malawi, and Kibera, Kenya: implications for programmes?
Authors:
Zachariah, R; Tayler-Smith, K; Manzi, M; Massaquoi, M; Mwagomba, B; van Griensven, J; van Engelgem, I; Arnould, L; Schouten, E J; Chimbwandira, F M; Harries, A D
Journal:
Transactions of the Royal Society of Tropical Medicine and Hygiene
Abstract:
Among adults eligible for antiretroviral therapy (ART) in Thyolo (rural Malawi) and Kibera (Nairobi, Kenya), this study (a) reports on retention and attrition during the preparation phase and after starting ART and (b) identifies risk factors associated with attrition. 'Retention' implies being alive and on follow-up, whilst 'attrition' implies loss to follow-up, death or stopping treatment (if on ART). There were 11,309 ART-eligible patients from Malawi and 3633 from Kenya, of whom 8421 (74%) and 2792 (77%), respectively, went through the preparation phase and started ART. In Malawi, 2649 patients (23%) were lost to attrition in the preparation phase and 2189 (26%) after starting ART. Similarly, in Kenya 546 patients (15%) were lost to attrition in the ART preparation phase and 647 (23%) while on ART. Overall programme attrition was 43% (4838/11,309) for Malawi and 33% (1193/3633) for Kenya. Restricting cohort evaluation to 'on ART' (as is usually done) underestimates overall programme attrition by 38% in Malawi and 36% in Kenya. Risk factors associated with attrition in the preparation phase included male sex, age <35 years, advanced HIV/AIDS disease and increasing malnutrition. Considerable attrition occurs during the preparation phase of ART, and programme evaluations confined to on-treatment analysis significantly underestimate attrition. This has important operational implications, which are discussed here.
Affiliation:
Médecins sans Frontières, Medical Department (Operational Research), Brussels Operational Center, 68 Rue de Gasperich, L-1617, Luxembourg, Luxembourg. zachariah@internet.lu
Issue Date:
Aug-2011
URI:
http://hdl.handle.net/10144/143510
DOI:
10.1016/j.trstmh.2011.04.014
PubMed ID:
21724219
Language:
en
ISSN:
1878-3503
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorZachariah, Ren
dc.contributor.authorTayler-Smith, Ken
dc.contributor.authorManzi, Men
dc.contributor.authorMassaquoi, Men
dc.contributor.authorMwagomba, Ben
dc.contributor.authorvan Griensven, Jen
dc.contributor.authorvan Engelgem, Ien
dc.contributor.authorArnould, Len
dc.contributor.authorSchouten, E Jen
dc.contributor.authorChimbwandira, F Men
dc.contributor.authorHarries, A Den
dc.date.accessioned2011-09-28T22:26:58Z-
dc.date.available2011-09-28T22:26:58Z-
dc.date.issued2011-08-
dc.identifier.citationRetention and attrition during the preparation phase and after start of antiretroviral treatment in Thyolo, Malawi, and Kibera, Kenya: implications for programmes? 2011, 105 (8):421-30 Trans. R. Soc. Trop. Med. Hyg.en
dc.identifier.issn1878-3503-
dc.identifier.pmid21724219-
dc.identifier.doi10.1016/j.trstmh.2011.04.014-
dc.identifier.urihttp://hdl.handle.net/10144/143510-
dc.description.abstractAmong adults eligible for antiretroviral therapy (ART) in Thyolo (rural Malawi) and Kibera (Nairobi, Kenya), this study (a) reports on retention and attrition during the preparation phase and after starting ART and (b) identifies risk factors associated with attrition. 'Retention' implies being alive and on follow-up, whilst 'attrition' implies loss to follow-up, death or stopping treatment (if on ART). There were 11,309 ART-eligible patients from Malawi and 3633 from Kenya, of whom 8421 (74%) and 2792 (77%), respectively, went through the preparation phase and started ART. In Malawi, 2649 patients (23%) were lost to attrition in the preparation phase and 2189 (26%) after starting ART. Similarly, in Kenya 546 patients (15%) were lost to attrition in the ART preparation phase and 647 (23%) while on ART. Overall programme attrition was 43% (4838/11,309) for Malawi and 33% (1193/3633) for Kenya. Restricting cohort evaluation to 'on ART' (as is usually done) underestimates overall programme attrition by 38% in Malawi and 36% in Kenya. Risk factors associated with attrition in the preparation phase included male sex, age <35 years, advanced HIV/AIDS disease and increasing malnutrition. Considerable attrition occurs during the preparation phase of ART, and programme evaluations confined to on-treatment analysis significantly underestimate attrition. This has important operational implications, which are discussed here.en
dc.language.isoenen
dc.rightsPublished by Elsevier Archived on this site with the kind permission of Elsevier Ltd. ([url]http://www.sciencedirect.com/science/journal/00359203[/url]) and the Royal Society of Tropical Medicine and Hygiene ([url]http://www.rstmh.org/transactions.asp[/url])en
dc.titleRetention and attrition during the preparation phase and after start of antiretroviral treatment in Thyolo, Malawi, and Kibera, Kenya: implications for programmes?en
dc.contributor.departmentMédecins sans Frontières, Medical Department (Operational Research), Brussels Operational Center, 68 Rue de Gasperich, L-1617, Luxembourg, Luxembourg. zachariah@internet.luen
dc.identifier.journalTransactions of the Royal Society of Tropical Medicine and Hygieneen

Related articles on PubMed

All Items in MSF are protected by copyright, with all rights reserved, unless otherwise indicated.