Variation in attrition at sub-national level: Review of the Botswana National HIV/AIDS Treatment (Masa) program data (2002–2013)
Identifieur interne : 000928 ( Pmc/Checkpoint ); précédent : 000927; suivant : 000929Variation 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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<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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<journal-id journal-id-type="pubmed-jr-id">20323</journal-id>
<journal-id journal-id-type="nlm-ta">Trop Med Int Health</journal-id>
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<title-group><article-title>Variation in attrition at sub-national level: Review of the Botswana National HIV/AIDS Treatment (Masa) program data (2002–2013)</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Farahani</surname>
<given-names>Mansour</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Price</surname>
<given-names>Natalie</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>El-Halabi</surname>
<given-names>Shenaaz</given-names>
</name>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Mlaudzi</surname>
<given-names>Naledi</given-names>
</name>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Keapoletswe</surname>
<given-names>Koona</given-names>
</name>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Lebelonyane</surname>
<given-names>Refeletswe</given-names>
</name>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Fetogang</surname>
<given-names>Ernest Benny</given-names>
</name>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Chebani</surname>
<given-names>Tony</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kebaabetswe</surname>
<given-names>Poloko</given-names>
</name>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Masupe</surname>
<given-names>Tiny</given-names>
</name>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Gabaake</surname>
<given-names>Keba</given-names>
</name>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Auld</surname>
<given-names>Andrew</given-names>
</name>
<xref ref-type="aff" rid="A4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Nkomazana</surname>
<given-names>Oathokwa</given-names>
</name>
<xref ref-type="aff" rid="A3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Marlink</surname>
<given-names>Richard</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>1</label>
Harvard T.H. Chan School of Public Health, Boston, MA, USA</aff>
<aff id="A2"><label>2</label>
Ministry of Health, Gaborone, Botswana</aff>
<aff id="A3"><label>3</label>
University of Botswana, Gaborone, Botswana</aff>
<aff id="A4"><label>4</label>
Centers for Disease Control and Prevention, Atlanta, GA, USA</aff>
<author-notes><corresp id="cor1"><bold>Corresponding author:</bold>
Mansour Farahani, Harvard T.H. Chan School of Public Health, Boston, MA, USA. <email>mfarahan@hsph.harvard.edu</email>
</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>30</day>
<month>3</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="epub"><day>12</day>
<month>11</month>
<year>2015</year>
</pub-date>
<pub-date pub-type="ppub"><month>1</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>01</day>
<month>1</month>
<year>2017</year>
</pub-date>
<volume>21</volume>
<issue>1</issue>
<fpage>18</fpage>
<lpage>27</lpage>
<pmc-comment>elocation-id from pubmed: 10.1111/tmi.12623</pmc-comment>
<abstract><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>
</abstract>
<kwd-group><kwd>HIV</kwd>
<kwd>attrition</kwd>
<kwd>ART</kwd>
<kwd>marginal structural model</kwd>
<kwd>multilevel</kwd>
<kwd>Botswana</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>Botswana</li>
<li>États-Unis</li>
</country>
<region><li>Géorgie (États-Unis)</li>
<li>Massachusetts</li>
</region>
</list>
<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>
</region>
<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>
</country>
<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>
</noRegion>
<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>
</affiliations>
</record>
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