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?


Tayler-Smith, K; Zachariah, R; Massaquoi, M; Manzi, M; Pasulani, O; van Den Akker, T; Bemelmans, M; Bauernfeind, A; Mwagomba, B; Harries, AD; (2010) 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? Transactions of the Royal Society of Tropical Medicine and Hygiene, 104 (5). pp. 313-319. ISSN 0035-9203 DOI: https://doi.org/10.1016/j.trstmh.2010.01.007

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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 >= 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. (C) 2010 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.

Item Type: Article
Keywords: HIV/AIDS, CD4 count, WHO stages 1 and 2, Follow-up, Attrition, Malawi, RESOURCE-POOR SETTINGS, SUB-SAHARAN AFRICA, ANTIRETROVIRAL TREATMENT, EARLY MORTALITY, SOUTH-AFRICA, THERAPY, OUTCOMES, COUNTRIES, SURVIVAL, DISTRICT
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
PubMed ID: 20138323
Web of Science ID: 277881200002
URI: http://researchonline.lshtm.ac.uk/id/eprint/3521

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