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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Patient volume, human resource levels, and attrition from HIV treatment programs in central Mozambique
Journal of Acquired Immune Deficiency Syndromes, Volume 57, No. 3, Year 2011
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Description
Introduction: Human resource shortages are viewed as one of the primary obstacles to provide effective services to growing patient populations receiving antiretroviral therapy (ART) and to expand ART access further. We examined the relationship of patient volume, human resource levels, and patient characteristics with attrition from HIV treatment programs in central Mozambique. Methods: We conducted a retrospective cohort study of adult, ART-naive, nonpregnant patients who initiated ART between January 2006 and June 2008 in the national HIV care program. Cox proportional hazards models were used to assess the association of patient volume, clinical staff burden, and pharmacy staff burden with attrition, adjusting for patient characteristics. Results: A total of 11,793 patients from 18 clinics were studied. After adjusting for patient characteristics, patients attending clinics with medium pharmacy staff burden [hazard ratio (HR) = 1.39 (95% CI: 1.07 to 1.80)] and high pharmacy staff burden [HR = 2.09 (95% CI: 1.50 to 2.91)] tended to have a higher risk of attrition (P value for trend: <0.001). Patients attending clinics with higher clinical staff burden did not have a statistically higher risk of attrition. Patients attending clinics with medium patient volume levels [HR = 1.45 (95% CI: 1.04 to 2.04)] and high patient volume levels [HR = 1.41 (95% CI: 1.04 to 1.92)] had a higher risk of attrition, but the trend test was not significant (P = 0.198). DISCUSSION:: Patients attending clinics with higher pharmacy staff burden had a higher risk of attrition. These results highlight a potential area within the health system where interventions could be applied to improve the retention of these patient populations. © 2011 Lippincott Williams & Wilkins.
Authors & Co-Authors
Lambdin, Barrot Hopkins
United States, Oakland
Pangaea Global Aids Foundation
Micek, Mark A.
United States, Seattle
University of Washington
United States, Seattle
Health Alliance International
Koepsell, Thomas D.
United States, Seattle
University of Washington
Hughes, James P.
United States, Seattle
University of Washington
Sherr, Kenneth H.
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
Kariaganis, Marina
Mozambique, Maputo
Ministry of Health Mozambique
Lara, Joseph
United States, Seattle
Health Alliance International
Gloyd, Stephen S.
United States, Seattle
University of Washington
United States, Seattle
Health Alliance International
Stergachis, Andy S.
United States, Oakland
Pangaea Global Aids Foundation
United States, Seattle
University of Washington
Statistics
Citations: 39
Authors: 10
Affiliations: 4
Identifiers
Doi:
10.1097/QAI.0b013e3182167e90
ISSN:
15254135
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Study Design
Cohort Study
Study Approach
Quantitative
Study Locations
Mozambique