Facility-Level Factors Influencing Retention of Patients in HIV Care in East Africa.
Losses to follow-up (LTFU) remain an important programmatic challenge. While numerous patient-level factors have been associated with LTFU, less is known about facility-level factors. Data from the East African International epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium was used to...
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2016-01-01
|
| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC4980048?pdf=render |
| _version_ | 1828343257048809472 |
|---|---|
| author | Beth Rachlis Giorgos Bakoyannis Philippa Easterbrook Becky Genberg Ronald Scott Braithwaite Craig R Cohen Elizabeth A Bukusi Andrew Kambugu Mwebesa Bosco Bwana Geoffrey R Somi Elvin H Geng Beverly Musick Constantin T Yiannoutsos Kara Wools-Kaloustian Paula Braitstein |
| author_facet | Beth Rachlis Giorgos Bakoyannis Philippa Easterbrook Becky Genberg Ronald Scott Braithwaite Craig R Cohen Elizabeth A Bukusi Andrew Kambugu Mwebesa Bosco Bwana Geoffrey R Somi Elvin H Geng Beverly Musick Constantin T Yiannoutsos Kara Wools-Kaloustian Paula Braitstein |
| author_sort | Beth Rachlis |
| collection | DOAJ |
| description | Losses to follow-up (LTFU) remain an important programmatic challenge. While numerous patient-level factors have been associated with LTFU, less is known about facility-level factors. Data from the East African International epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium was used to identify facility-level factors associated with LTFU in Kenya, Tanzania and Uganda. Patients were defined as LTFU if they had no visit within 12 months of the study endpoint for pre-ART patients or 6 months for patients on ART. Adjusting for patient factors, shared frailty proportional hazard models were used to identify the facility-level factors associated with LTFU for the pre- and post-ART periods. Data from 77,362 patients and 29 facilities were analyzed. Median age at enrolment was 36.0 years (Interquartile Range: 30.1, 43.1), 63.9% were women and 58.3% initiated ART. Rates (95% Confidence Interval) of LTFU were 25.1 (24.7-25.6) and 16.7 (16.3-17.2) per 100 person-years in the pre-ART and post-ART periods, respectively. Facility-level factors associated with increased LTFU included secondary-level care, HIV RNA PCR turnaround time >14 days, and no onsite availability of CD4 testing. Increased LTFU was also observed when no nutritional supplements were provided (pre-ART only), when TB patients were treated within the HIV program (pre-ART only), and when the facility was open ≤4 mornings per week (ART only). Our findings suggest that facility-based strategies such as point of care laboratory testing and separate clinic spaces for TB patients may improve retention. |
| first_indexed | 2024-04-13T23:40:20Z |
| format | Article |
| id | doaj.art-f296e54838c049648fff0f8440799eee |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-13T23:40:20Z |
| publishDate | 2016-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-f296e54838c049648fff0f8440799eee2022-12-22T02:24:33ZengPublic Library of Science (PLoS)PLoS ONE1932-62032016-01-01118e015999410.1371/journal.pone.0159994Facility-Level Factors Influencing Retention of Patients in HIV Care in East Africa.Beth RachlisGiorgos BakoyannisPhilippa EasterbrookBecky GenbergRonald Scott BraithwaiteCraig R CohenElizabeth A BukusiAndrew KambuguMwebesa Bosco BwanaGeoffrey R SomiElvin H GengBeverly MusickConstantin T YiannoutsosKara Wools-KaloustianPaula BraitsteinLosses to follow-up (LTFU) remain an important programmatic challenge. While numerous patient-level factors have been associated with LTFU, less is known about facility-level factors. Data from the East African International epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium was used to identify facility-level factors associated with LTFU in Kenya, Tanzania and Uganda. Patients were defined as LTFU if they had no visit within 12 months of the study endpoint for pre-ART patients or 6 months for patients on ART. Adjusting for patient factors, shared frailty proportional hazard models were used to identify the facility-level factors associated with LTFU for the pre- and post-ART periods. Data from 77,362 patients and 29 facilities were analyzed. Median age at enrolment was 36.0 years (Interquartile Range: 30.1, 43.1), 63.9% were women and 58.3% initiated ART. Rates (95% Confidence Interval) of LTFU were 25.1 (24.7-25.6) and 16.7 (16.3-17.2) per 100 person-years in the pre-ART and post-ART periods, respectively. Facility-level factors associated with increased LTFU included secondary-level care, HIV RNA PCR turnaround time >14 days, and no onsite availability of CD4 testing. Increased LTFU was also observed when no nutritional supplements were provided (pre-ART only), when TB patients were treated within the HIV program (pre-ART only), and when the facility was open ≤4 mornings per week (ART only). Our findings suggest that facility-based strategies such as point of care laboratory testing and separate clinic spaces for TB patients may improve retention.http://europepmc.org/articles/PMC4980048?pdf=render |
| spellingShingle | Beth Rachlis Giorgos Bakoyannis Philippa Easterbrook Becky Genberg Ronald Scott Braithwaite Craig R Cohen Elizabeth A Bukusi Andrew Kambugu Mwebesa Bosco Bwana Geoffrey R Somi Elvin H Geng Beverly Musick Constantin T Yiannoutsos Kara Wools-Kaloustian Paula Braitstein Facility-Level Factors Influencing Retention of Patients in HIV Care in East Africa. PLoS ONE |
| title | Facility-Level Factors Influencing Retention of Patients in HIV Care in East Africa. |
| title_full | Facility-Level Factors Influencing Retention of Patients in HIV Care in East Africa. |
| title_fullStr | Facility-Level Factors Influencing Retention of Patients in HIV Care in East Africa. |
| title_full_unstemmed | Facility-Level Factors Influencing Retention of Patients in HIV Care in East Africa. |
| title_short | Facility-Level Factors Influencing Retention of Patients in HIV Care in East Africa. |
| title_sort | facility level factors influencing retention of patients in hiv care in east africa |
| url | http://europepmc.org/articles/PMC4980048?pdf=render |
| work_keys_str_mv | AT bethrachlis facilitylevelfactorsinfluencingretentionofpatientsinhivcareineastafrica AT giorgosbakoyannis facilitylevelfactorsinfluencingretentionofpatientsinhivcareineastafrica AT philippaeasterbrook facilitylevelfactorsinfluencingretentionofpatientsinhivcareineastafrica AT beckygenberg facilitylevelfactorsinfluencingretentionofpatientsinhivcareineastafrica AT ronaldscottbraithwaite facilitylevelfactorsinfluencingretentionofpatientsinhivcareineastafrica AT craigrcohen facilitylevelfactorsinfluencingretentionofpatientsinhivcareineastafrica AT elizabethabukusi facilitylevelfactorsinfluencingretentionofpatientsinhivcareineastafrica AT andrewkambugu facilitylevelfactorsinfluencingretentionofpatientsinhivcareineastafrica AT mwebesaboscobwana facilitylevelfactorsinfluencingretentionofpatientsinhivcareineastafrica AT geoffreyrsomi facilitylevelfactorsinfluencingretentionofpatientsinhivcareineastafrica AT elvinhgeng facilitylevelfactorsinfluencingretentionofpatientsinhivcareineastafrica AT beverlymusick facilitylevelfactorsinfluencingretentionofpatientsinhivcareineastafrica AT constantintyiannoutsos facilitylevelfactorsinfluencingretentionofpatientsinhivcareineastafrica AT karawoolskaloustian facilitylevelfactorsinfluencingretentionofpatientsinhivcareineastafrica AT paulabraitstein facilitylevelfactorsinfluencingretentionofpatientsinhivcareineastafrica |