Low mortality risk but high loss to follow-up among patients in the Tanzanian national HIV care and treatment programme

Objective To analyse survival and retention rates of the Tanzanian care and treatment programme. Methods Routine patient-level data were available from 101 of 909 clinics. Kaplan-Meier probabilities of mortality and attrition after ART initiation were calculated. Mortality risks were corrected for biases from loss to follow-up using Egger's nomogram. Smoothed hazard rates showed mortality and attrition peaks. Cox regression identified factors associated with death and attrition. Median CD4 counts were calculated at 6month intervals. Results In 88,875 adults, 18% were lost to follow up 12months after treatment initiation, and 36% after 36months. Cumulative mortality reached 10% by 12months (15% after correcting for loss to follow-up) and 14% by 36months. Mortality and attrition rates both peaked within the first six months, and were higher among males, those under 45kg and those with CD4 counts below 50cells/μl at ART initiation. In the first year on ART, median CD4 count increased by 126cells/μl, with similar changes in both sexes. Conclusion Earlier diagnoses through expanded HIV testing may reduce high mortality and attrition rates if combined with better patient tracing systems. Further research is needed to explore reasons for attrition. © 2012 Blackwell Publishing Ltd.