Variation in attrition at sub-national level: Review of the Botswana National HIV/AIDS Treatment (Masa) program data (2002–2013)
Identifieur interne : 003387 ( Ncbi/Checkpoint ); précédent : 003386; suivant : 003388Variation in attrition at sub-national level: Review of the Botswana National HIV/AIDS Treatment (Masa) program data (2002–2013)
Auteurs : Mansour Farahani [États-Unis] ; Natalie Price [États-Unis] ; Shenaaz El-Halabi [Botswana] ; Naledi Mlaudzi [Botswana] ; Koona Keapoletswe [Botswana] ; Refeletswe Lebelonyane [Botswana] ; Ernest Benny Fetogang [Botswana] ; Tony Chebani [États-Unis] ; Poloko Kebaabetswe [Botswana] ; Tiny Masupe [Botswana] ; Keba Gabaake [Botswana] ; Andrew Auld [États-Unis] ; Oathokwa Nkomazana [Botswana] ; Richard Marlink [États-Unis]Source :
- Tropical medicine & international health : TM & IH [ 1360-2276 ] ; 2015.
Abstract
To evaluate the variation in all-cause attrition (mortality and loss to follow-up (LTFU)) among HIV-infected individuals in Botswana by health district during the rapid and massive scale-up of the National Treatment Program.
Analysis of routinely collected longitudinal data from 226,030 patients who received ART through the Botswana National HIV/AIDS Treatment Program across all 24 health districts from 2002 to 2013. A time-to-event analysis was used to measure crude mortality and loss to follow-up rates (LTFU). A marginal structural model was used to evaluate mortality and LTFU rates by district over time, adjusted for individual-level risk factors (e.g., age, gender, baseline CD4, year of treatment initiation, and antiretroviral regimen).
Mortality rates in the districts ranged from the lowest 1.0 (95% CI 0.9–1.1) in Selibe-Phikwe, to the highest 5.0 (95% CI 4.0–6.1), in Mabutsane. There was a wide range of overall LTFU across districts, including rates as low as 4.6 (95% CI 4.4–4.9) losses per 100 person-years in Ngamiland, and 5.9 (95% CI 5.6–6.2) losses per 100 person-years in South East, to rates as high as 25.4 (95% CI 23.08–27.89) losses per 100 person-years in Mabutsane and 46.3 (95% CI 43.48–49.23) losses per 100 person-years in Okavango. Even when known risk factors for mortality and LTFU were adjusted for, district was a significant predictor of both mortality and LTFU rates
We found statistically significant variation in attrition (mortality and LTFU) and data quality among districts. These findings suggest that district-level contextual factors affect retention in treatment. Further research needs to investigate factors that can potentially cause this variation.
Url:
DOI: 10.1111/tmi.12623
PubMed: 26485172
PubMed Central: 4834839
Affiliations:
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<author><name sortKey="Kebaabetswe, Poloko" sort="Kebaabetswe, Poloko" uniqKey="Kebaabetswe P" first="Poloko" last="Kebaabetswe">Poloko Kebaabetswe</name>
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<front><div type="abstract" xml:lang="en"><sec id="S1"><title>Objective</title>
<p id="P1">To evaluate the variation in all-cause attrition (mortality and loss to follow-up (LTFU)) among HIV-infected individuals in Botswana by health district during the rapid and massive scale-up of the National Treatment Program.</p>
</sec>
<sec id="S2"><title>Methods</title>
<p id="P2">Analysis of routinely collected longitudinal data from 226,030 patients who received ART through the Botswana National HIV/AIDS Treatment Program across all 24 health districts from 2002 to 2013. A time-to-event analysis was used to measure crude mortality and loss to follow-up rates (LTFU). A marginal structural model was used to evaluate mortality and LTFU rates by district over time, adjusted for individual-level risk factors (e.g., age, gender, baseline CD4, year of treatment initiation, and antiretroviral regimen).</p>
</sec>
<sec id="S3"><title>Results</title>
<p id="P3">Mortality rates in the districts ranged from the lowest 1.0 (95% CI 0.9–1.1) in Selibe-Phikwe, to the highest 5.0 (95% CI 4.0–6.1), in Mabutsane. There was a wide range of overall LTFU across districts, including rates as low as 4.6 (95% CI 4.4–4.9) losses per 100 person-years in Ngamiland, and 5.9 (95% CI 5.6–6.2) losses per 100 person-years in South East, to rates as high as 25.4 (95% CI 23.08–27.89) losses per 100 person-years in Mabutsane and 46.3 (95% CI 43.48–49.23) losses per 100 person-years in Okavango. Even when known risk factors for mortality and LTFU were adjusted for, district was a significant predictor of both mortality and LTFU rates</p>
</sec>
<sec id="S4"><title>Conclusion</title>
<p id="P4">We found statistically significant variation in attrition (mortality and LTFU) and data quality among districts. These findings suggest that district-level contextual factors affect retention in treatment. Further research needs to investigate factors that can potentially cause this variation.</p>
</sec>
</div>
</front>
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<affiliations><list><country><li>Botswana</li>
<li>États-Unis</li>
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<region><li>Géorgie (États-Unis)</li>
<li>Massachusetts</li>
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<tree><country name="États-Unis"><region name="Massachusetts"><name sortKey="Farahani, Mansour" sort="Farahani, Mansour" uniqKey="Farahani M" first="Mansour" last="Farahani">Mansour Farahani</name>
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<name sortKey="Auld, Andrew" sort="Auld, Andrew" uniqKey="Auld A" first="Andrew" last="Auld">Andrew Auld</name>
<name sortKey="Chebani, Tony" sort="Chebani, Tony" uniqKey="Chebani T" first="Tony" last="Chebani">Tony Chebani</name>
<name sortKey="Marlink, Richard" sort="Marlink, Richard" uniqKey="Marlink R" first="Richard" last="Marlink">Richard Marlink</name>
<name sortKey="Price, Natalie" sort="Price, Natalie" uniqKey="Price N" first="Natalie" last="Price">Natalie Price</name>
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<country name="Botswana"><noRegion><name sortKey="El Halabi, Shenaaz" sort="El Halabi, Shenaaz" uniqKey="El Halabi S" first="Shenaaz" last="El-Halabi">Shenaaz El-Halabi</name>
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<name sortKey="Fetogang, Ernest Benny" sort="Fetogang, Ernest Benny" uniqKey="Fetogang E" first="Ernest Benny" last="Fetogang">Ernest Benny Fetogang</name>
<name sortKey="Gabaake, Keba" sort="Gabaake, Keba" uniqKey="Gabaake K" first="Keba" last="Gabaake">Keba Gabaake</name>
<name sortKey="Keapoletswe, Koona" sort="Keapoletswe, Koona" uniqKey="Keapoletswe K" first="Koona" last="Keapoletswe">Koona Keapoletswe</name>
<name sortKey="Kebaabetswe, Poloko" sort="Kebaabetswe, Poloko" uniqKey="Kebaabetswe P" first="Poloko" last="Kebaabetswe">Poloko Kebaabetswe</name>
<name sortKey="Lebelonyane, Refeletswe" sort="Lebelonyane, Refeletswe" uniqKey="Lebelonyane R" first="Refeletswe" last="Lebelonyane">Refeletswe Lebelonyane</name>
<name sortKey="Masupe, Tiny" sort="Masupe, Tiny" uniqKey="Masupe T" first="Tiny" last="Masupe">Tiny Masupe</name>
<name sortKey="Mlaudzi, Naledi" sort="Mlaudzi, Naledi" uniqKey="Mlaudzi N" first="Naledi" last="Mlaudzi">Naledi Mlaudzi</name>
<name sortKey="Nkomazana, Oathokwa" sort="Nkomazana, Oathokwa" uniqKey="Nkomazana O" first="Oathokwa" last="Nkomazana">Oathokwa Nkomazana</name>
</country>
</tree>
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