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?

Katie Tayler-Smith; Rony Zachariah; Moses Massaquoi; Marcel Manzi; Olesi Pasulani; Thomas van den Akker; Marielle Bemelmans; Ariane Bauernfeind; Beatrice Mwagomba; Anthony D. Harries

doi:10.1016/j.trstmh.2010.01.007

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?

Katie Tayler-Smith
, Rony Zachariah^*
, Moses Massaquoi
, Marcel Manzi
, Olesi Pasulani
, Thomas van den Akker
, Marielle Bemelmans
, Ariane Bauernfeind
, Beatrice Mwagomba
, Anthony D. Harries

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

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/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.

Original language	English
Pages (from-to)	313-319
Number of pages	7
Journal	Transactions of the Royal Society of Tropical Medicine and Hygiene
Volume	104
Issue number	5
DOIs	https://doi.org/10.1016/j.trstmh.2010.01.007
Publication status	Published - 1 May 2010
Externally published	Yes

Funding

The Thyolo District HIV/AIDS programme is supported by Médecins sans Frontières. We are also very grateful to EuropeAid, DGCD (Belgium Government), CIFF and ELMA Foundation, the Global Fund, and WHO for their continuing support for HIV/AIDS activities in Malawi.

Keywords

Attrition
CD4 count
Follow-up
HIV/AIDS
Malawi
WHO stages 1 and 2

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10.1016/j.trstmh.2010.01.007

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Tayler-Smith, K., Zachariah, R., Massaquoi, M., Manzi, M., Pasulani, O., van den Akker, T., Bemelmans, M., Bauernfeind, A., Mwagomba, B., & Harries, A. D. (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), 313-319. 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/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.",

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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, vol. 104, no. 5, pp. 313-319. https://doi.org/10.1016/j.trstmh.2010.01.007

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, Katie; Zachariah, Rony; Massaquoi, Moses et al.
In: Transactions of the Royal Society of Tropical Medicine and Hygiene, Vol. 104, No. 5, 01.05.2010, p. 313-319.

Research output: Contribution to Journal › Article › Academic › peer-review

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Tayler-Smith K, Zachariah R, Massaquoi M, Manzi M, Pasulani O, van den Akker T et al. 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. 2010 May 1;104(5):313-319. doi: 10.1016/j.trstmh.2010.01.007

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?

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Keywords

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