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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Integration of HIV care and treatment in primary health care centers and patient retention in central mozambique: A retrospective cohort study
Journal of Acquired Immune Deficiency Syndromes, Volume 62, No. 5, Year 2013
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Description
Background: In 2004, the Mozambican Ministry of Health began a national scale-up of antiretroviral therapy (ART) using a vertical model of HIV clinics colocated within large urban hospitals. In 2006, the ministry expanded access by integrating ART into primary health care clinics. Methods: We conducted a retrospective cohort study including adult ART-naive patients initiating ART between January 2006 and June 2008 in public sector clinics in Manica and Sofala provinces. Cox proportional hazards models with robust variances were used to estimate the association between clinic model (vertical/integrated), clinic location (urban/rural), and clinic experience (first 6 months/post first 6 months) and attrition occurring in early patient follow-up (#6 months) and attrition occurring in late patient follow-up (.6 months), while controlling for age, sex, education, pre-ART CD4 count, World Health Organization stage and pharmacy staff burden. Results: A total of 11,775 patients from 17 clinics were studied. The overall attrition rate was 37 per 100 person-years. Patients attending integrated clinics had a higher risk of attrition in late follow-up [hazard ratio (HR) = 1.75; 95% confidence interval (CI): 1.04 to 2.94], and patients attending urban clinics (HR = 0.57; 95% CI: 0.35 to 0.91) had a lower risk of attrition in late follow-up. Though not statistically significant, clinics open for longer than 6 months (HR = 0.71; 95% CI: 0.49 to 1.04) had a lower risk of attrition in early follow-up. Conclusions: Patients attending vertical clinics had a lower risk of attrition. Utilizing primary health clinics to implement ART is necessary to reach higher levels of coverage; however, further implementation strategies should be developed to improve patient retention in these settings. Copyright © 2012 by Lippincott Williams & Wilkins.
Authors & Co-Authors
Lambdin, Barrot Hopkins
United States, Oakland
Pangaea Global Aids Foundation
United States, Seattle
University of Washington
Micek, Mark A.
United States, Seattle
University of Washington
United States, Seattle
Health Alliance International
Sherr, Kenneth H.
United States, Seattle
University of Washington
United States, Seattle
Health Alliance International
Gimbel, Sarah O.
United States, Seattle
University of Washington
United States, Seattle
Health Alliance International
Kariaganis, Marina
Mozambique, Maputo
Ministry of Health Mozambique
Lara, Joseph
Mozambique, Maputo
Ministry of Health Mozambique
Gloyd, Stephen S.
United States, Seattle
University of Washington
United States, Seattle
Health Alliance International
Pfeiffer, James T.
United States, Seattle
University of Washington
United States, Seattle
Health Alliance International
Statistics
Citations: 34
Authors: 8
Affiliations: 4
Identifiers
Doi:
10.1097/QAI.0b013e3182840d4e
ISSN:
15254135
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
Mozambique