Retention in care for patients receiving highly activeantiretroviral therapy at Health care facilities: The situation in Zambia
Date
2014-05-23
Authors
Lembela, Deophine
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Abstract
Background:Retaining in care for patients initiated on HAART is a challenge for health care facilities where patients are being lost at different points in the continuum of care. General Objective:To determine the extent of retention in care for patients receiving highly active antiretroviral therapy (HAART)12 months after initiating antiretroviral therapy at health care facilities in Zambia.Methods:This study was a retrospective cohort study using secondary data from a study conducted by Boston University and the Zambia Center for Applied Health Research and Development. The study sample included 896 patients from six treatment sites in Zambia.We enrolled a total of 896 adult patients (>15 years of age) who initiated HAART in 2007 and 2008 at 6 six health care facilities in Zambia. Pearson’s chi-squared test was used to determine the association of each independent variable with retention in care. Binomial logistic regression was used to calculate risk ratios and confidence intervals for variables that were found to be significantly associated with retention in care.
Results:A total of 73.9% patients remained in care one year after HAART initiation. The median age at HAART initiation was 34.9 years [IQR 26.8-42.5); median CD4 cell count was 145cells/µL [IQR 82-212]; and 40.0% of the cohort were males. Retention was not significantly associated with site, facility level (hospital, clinic), setting (urban, rural), year of treatment initiation (2007, 2008), age at initiation, regimen at initiation, or gender, although there were observed variations. Retention in care varied significantly based on CD4 count, from as high as 81.2% for patients with CD4 cell counts at initiation of 200-350 cells/µL to as low as 62.0% for patients with CD4 cell counts ≥350 cells/µL. Furthermore, patients with CD4 cell count of below 100 cells/µL had a higher retention rate (67.0%) compared to those with CD4 cell count of above 350 cells/µL. Patients with CD4 cell count of between 100 and 200 cells/µL, and between 200 and 350 cells/µL were 1.6 and 2.1 times more likely to remain in care compared with those patients with CD4 cell count of below 100 cells/µL respectively. Patients with CD4 cell count of above 350cells/µL were less likely to remain in care compared to those with CD4 cell count of below 100cells/µL [RR= (0.93, 95% CI.92-1.19)].Conclusion:A large proportion of adult patients initiating HAART in Zambia are not retained in care one year after initiation. Of all the variables that were examined only CD4 count was significantly associated with retention in care. Significantly worse retention for patients with lower CD4 cell count at initiation suggests the need for earlier identification and initiation of patients on HAART, enhanced linkages with community based HIV/AIDS organizations, and opportunity for targeted retention interventions for this higher risk group. The findings are comparable with other studies on retention and attrition rates in HAART programmes in Africa. Finally, this study might be an indication that calendar year of HAART initiation, gender, regimen at HAART initiation, age at initiation, facility type (setting and level) might not be cardinal in efforts to address retention issues.
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AIDS(Disease)-treatment-Zambia