TY - JOUR
T1 - Unacceptable attrition among WHO stages 1 and 2 patients in a hospital-based setting in rural Malawi
T2 - Can we retain such patients within the general health system?
AU - Tayler-Smith, Katie
AU - Zachariah, Rony
AU - Massaquoi, Moses
AU - Manzi, Marcel
AU - Pasulani, Olesi
AU - van den Akker, Thomas
AU - Bemelmans, Marielle
AU - Bauernfeind, Ariane
AU - Mwagomba, Beatrice
AU - Harries, Anthony D.
PY - 2010/5/1
Y1 - 2010/5/1
N2 - 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/mm3. 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.
AB - 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/mm3. 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.
KW - Attrition
KW - CD4 count
KW - Follow-up
KW - HIV/AIDS
KW - Malawi
KW - WHO stages 1 and 2
UR - http://www.scopus.com/inward/record.url?scp=77952951032&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77952951032&partnerID=8YFLogxK
U2 - 10.1016/j.trstmh.2010.01.007
DO - 10.1016/j.trstmh.2010.01.007
M3 - Article
C2 - 20138323
AN - SCOPUS:77952951032
SN - 0035-9203
VL - 104
SP - 313
EP - 319
JO - Transactions of the Royal Society of Tropical Medicine and Hygiene
JF - Transactions of the Royal Society of Tropical Medicine and Hygiene
IS - 5
ER -