Unacceptable attrition among WHO stages 1 and 2 patients in a hospital-based setting in rural Malawi: can we retain such patients within the general health system?

Hdl Handle:
http://hdl.handle.net/10144/98743
Title:
Unacceptable attrition among WHO stages 1 and 2 patients in a hospital-based setting in rural Malawi: can we retain such patients within the general health system?
Authors:
Tayler-Smith, Katie; Zachariah, Rony; Massaquoi, M; Massaquoi, M; Manzi, Marcel; Pasulani, Olesi; van den Akker, Thomas; Bemelmans, Marielle; Bauernfeind, Ariane; Mwagomba, Beatrice; Harries, Anthony D
Journal:
Transactions of the Royal Society of Tropical Medicine and Hygiene
Abstract:
A study conducted among HIV-positive adults in WHO clinical stages 1 and 2 was followed up at Thyolo District Hospital (rural Malawi) to report on: (1) retention and attrition before and while on antiretroviral treatment (ART); and (2) the criteria used for initiating ART. Between June 2008 and January 2009, 1633 adults in WHO stages 1 and 2 were followed up for a total of 282 person-years. Retention in care at 1, 2, 3 and 6 months for those not on ART (n=1078) was 25, 18, 11 and 4% vs. 99, 97, 95 and 90% for patients who started ART (n=555, P=0.001). Attrition rates were 31 times higher among patients not started on ART compared with those started on ART (adjusted hazard ratio, 31.0, 95% CI 22-44). Ninety-two patients in WHO stage 1 or 2 were started on ART without the guidance of a CD4 count, and 11 were incorrectly started on ART with CD4 count > or = 250 cells/mm(3). In a rural district hospital setting in Malawi, attrition of individuals in WHO stages 1 and 2 is unacceptably high, and specific operational strategies need to be considered to retain such patients in the health system.
Affiliation:
Médecins sans Frontières, Medical Department (Operational Research), Brussels Operational Center, 68 Rue de Gasperich, L-1617, Luxembourg.
Issue Date:
May-2010
URI:
http://hdl.handle.net/10144/98743
DOI:
10.1016/j.trstmh.2010.01.007
PubMed ID:
20138323
Language:
en
ISSN:
1878-3503
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorTayler-Smith, Katieen
dc.contributor.authorZachariah, Ronyen
dc.contributor.authorMassaquoi, Men
dc.contributor.authorMassaquoi, Men
dc.contributor.authorManzi, Marcelen
dc.contributor.authorPasulani, Olesien
dc.contributor.authorvan den Akker, Thomasen
dc.contributor.authorBemelmans, Marielleen
dc.contributor.authorBauernfeind, Arianeen
dc.contributor.authorMwagomba, Beatriceen
dc.contributor.authorHarries, Anthony Den
dc.date.accessioned2010-05-13T19:59:16Z-
dc.date.available2010-05-13T19:59:16Z-
dc.date.issued2010-05-
dc.identifier.citationUnacceptable attrition among WHO stages 1 and 2 patients in a hospital-based setting in rural Malawi: can we retain such patients within the general health system? 2010, 104 (5):313-9 Trans. R. Soc. Trop. Med. Hyg.en
dc.identifier.issn1878-3503-
dc.identifier.pmid20138323-
dc.identifier.doi10.1016/j.trstmh.2010.01.007-
dc.identifier.urihttp://hdl.handle.net/10144/98743-
dc.description.abstractA study conducted among HIV-positive adults in WHO clinical stages 1 and 2 was followed up at Thyolo District Hospital (rural Malawi) to report on: (1) retention and attrition before and while on antiretroviral treatment (ART); and (2) the criteria used for initiating ART. Between June 2008 and January 2009, 1633 adults in WHO stages 1 and 2 were followed up for a total of 282 person-years. Retention in care at 1, 2, 3 and 6 months for those not on ART (n=1078) was 25, 18, 11 and 4% vs. 99, 97, 95 and 90% for patients who started ART (n=555, P=0.001). Attrition rates were 31 times higher among patients not started on ART compared with those started on ART (adjusted hazard ratio, 31.0, 95% CI 22-44). Ninety-two patients in WHO stage 1 or 2 were started on ART without the guidance of a CD4 count, and 11 were incorrectly started on ART with CD4 count > or = 250 cells/mm(3). In a rural district hospital setting in Malawi, attrition of individuals in WHO stages 1 and 2 is unacceptably high, and specific operational strategies need to be considered to retain such patients in the health system.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.titleUnacceptable attrition among WHO stages 1 and 2 patients in a hospital-based setting in rural Malawi: can we retain such patients within the general health system?en
dc.contributor.departmentMédecins sans Frontières, Medical Department (Operational Research), Brussels Operational Center, 68 Rue de Gasperich, L-1617, Luxembourg.en
dc.identifier.journalTransactions of the Royal Society of Tropical Medicine and Hygieneen

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