Variation in attrition at sub-national level: Review of the Botswana National HIV/AIDS Treatment (Masa) program data (2002–2013)
Identifieur interne : 001F15 ( Pmc/Curation ); précédent : 001F14; suivant : 001F16Variation 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.
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DOI: 10.1111/tmi.12623
PubMed: 26485172
PubMed Central: 4834839
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Chan School of Public Health, Boston, MA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Harvard T.H. 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Chan School of Public Health, Boston, MA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Harvard T.H. Chan School of Public Health, Boston, MA</wicri:regionArea></affiliation></author><author><name sortKey="Price, Natalie" sort="Price, Natalie" uniqKey="Price N" first="Natalie" last="Price">Natalie Price</name><affiliation wicri:level="1"><nlm:aff id="A1">Harvard T.H. Chan School of Public Health, Boston, MA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Harvard T.H. Chan School of Public Health, Boston, MA</wicri:regionArea></affiliation></author><author><name sortKey="El Halabi, Shenaaz" sort="El Halabi, Shenaaz" uniqKey="El Halabi S" first="Shenaaz" last="El-Halabi">Shenaaz El-Halabi</name><affiliation wicri:level="1"><nlm:aff id="A2">Ministry of Health, Gaborone, Botswana</nlm:aff><country xml:lang="fr">Botswana</country><wicri:regionArea>Ministry of Health, Gaborone</wicri:regionArea></affiliation></author><author><name sortKey="Mlaudzi, Naledi" sort="Mlaudzi, Naledi" uniqKey="Mlaudzi N" first="Naledi" last="Mlaudzi">Naledi Mlaudzi</name><affiliation wicri:level="1"><nlm:aff id="A2">Ministry of Health, Gaborone, Botswana</nlm:aff><country xml:lang="fr">Botswana</country><wicri:regionArea>Ministry of Health, Gaborone</wicri:regionArea></affiliation></author><author><name sortKey="Keapoletswe, Koona" sort="Keapoletswe, Koona" uniqKey="Keapoletswe K" first="Koona" last="Keapoletswe">Koona Keapoletswe</name><affiliation wicri:level="1"><nlm:aff id="A2">Ministry of Health, Gaborone, Botswana</nlm:aff><country xml:lang="fr">Botswana</country><wicri:regionArea>Ministry of Health, Gaborone</wicri:regionArea></affiliation></author><author><name sortKey="Lebelonyane, Refeletswe" sort="Lebelonyane, Refeletswe" uniqKey="Lebelonyane R" first="Refeletswe" last="Lebelonyane">Refeletswe Lebelonyane</name><affiliation wicri:level="1"><nlm:aff id="A2">Ministry of Health, Gaborone, Botswana</nlm:aff><country xml:lang="fr">Botswana</country><wicri:regionArea>Ministry of Health, Gaborone</wicri:regionArea></affiliation></author><author><name sortKey="Fetogang, Ernest Benny" sort="Fetogang, Ernest Benny" uniqKey="Fetogang E" first="Ernest Benny" last="Fetogang">Ernest Benny Fetogang</name><affiliation wicri:level="1"><nlm:aff id="A2">Ministry of Health, Gaborone, Botswana</nlm:aff><country xml:lang="fr">Botswana</country><wicri:regionArea>Ministry of Health, Gaborone</wicri:regionArea></affiliation></author><author><name sortKey="Chebani, Tony" sort="Chebani, Tony" uniqKey="Chebani T" first="Tony" last="Chebani">Tony Chebani</name><affiliation wicri:level="1"><nlm:aff id="A1">Harvard T.H. Chan School of Public Health, Boston, MA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Harvard T.H. Chan School of Public Health, Boston, MA</wicri:regionArea></affiliation></author><author><name sortKey="Kebaabetswe, Poloko" sort="Kebaabetswe, Poloko" uniqKey="Kebaabetswe P" first="Poloko" last="Kebaabetswe">Poloko Kebaabetswe</name><affiliation wicri:level="1"><nlm:aff id="A3">University of Botswana, Gaborone, Botswana</nlm:aff><country xml:lang="fr">Botswana</country><wicri:regionArea>University of Botswana, Gaborone</wicri:regionArea></affiliation></author><author><name sortKey="Masupe, Tiny" sort="Masupe, Tiny" uniqKey="Masupe T" first="Tiny" last="Masupe">Tiny Masupe</name><affiliation wicri:level="1"><nlm:aff id="A3">University of Botswana, Gaborone, Botswana</nlm:aff><country xml:lang="fr">Botswana</country><wicri:regionArea>University of Botswana, Gaborone</wicri:regionArea></affiliation></author><author><name sortKey="Gabaake, Keba" sort="Gabaake, Keba" uniqKey="Gabaake K" first="Keba" last="Gabaake">Keba Gabaake</name><affiliation wicri:level="1"><nlm:aff id="A3">University of Botswana, Gaborone, Botswana</nlm:aff><country xml:lang="fr">Botswana</country><wicri:regionArea>University of Botswana, Gaborone</wicri:regionArea></affiliation></author><author><name sortKey="Auld, Andrew" sort="Auld, Andrew" uniqKey="Auld A" first="Andrew" last="Auld">Andrew Auld</name><affiliation wicri:level="1"><nlm:aff id="A4">Centers for Disease Control and Prevention, Atlanta, GA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Centers for Disease Control and Prevention, Atlanta, GA</wicri:regionArea></affiliation></author><author><name sortKey="Nkomazana, Oathokwa" sort="Nkomazana, Oathokwa" uniqKey="Nkomazana O" first="Oathokwa" last="Nkomazana">Oathokwa Nkomazana</name><affiliation wicri:level="1"><nlm:aff id="A3">University of Botswana, Gaborone, Botswana</nlm:aff><country xml:lang="fr">Botswana</country><wicri:regionArea>University of Botswana, Gaborone</wicri:regionArea></affiliation></author><author><name sortKey="Marlink, Richard" sort="Marlink, Richard" uniqKey="Marlink R" first="Richard" last="Marlink">Richard Marlink</name><affiliation wicri:level="1"><nlm:aff id="A1">Harvard T.H. Chan School of Public Health, Boston, MA, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Harvard T.H. Chan School of Public Health, Boston, MA</wicri:regionArea></affiliation></author></analytic><series><title level="j">Tropical medicine & international health : TM & IH</title><idno type="ISSN">1360-2276</idno><idno type="eISSN">1365-3156</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><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></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">9610576</journal-id><journal-id journal-id-type="pubmed-jr-id">20323</journal-id><journal-id journal-id-type="nlm-ta">Trop Med Int Health</journal-id><journal-id journal-id-type="iso-abbrev">Trop. Med. Int. Health</journal-id><journal-title-group><journal-title>Tropical medicine & international health : TM & IH</journal-title></journal-title-group><issn pub-type="ppub">1360-2276</issn><issn pub-type="epub">1365-3156</issn></journal-meta><article-meta><article-id pub-id-type="pmid">26485172</article-id><article-id pub-id-type="pmc">4834839</article-id><article-id pub-id-type="doi">10.1111/tmi.12623</article-id><article-id pub-id-type="manuscript">HHSPA772845</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><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></record>Pour manipuler ce document sous Unix (Dilib)
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