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Association of Adherence Support and Outreach Services with Total Attrition, Loss to Follow-Up, and Death among ART Patients in Sub-Saharan Africa

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  • Matthew R Lamb
  • Wafaa M El-Sadr
  • Elvin Geng
  • Denis Nash

Abstract

Background: Loss to follow-up (LTF) after antiretroviral therapy (ART) initiation is common in HIV clinics. We examined the effect of availability of adherence support and active patient outreach services on patient attrition following ART initiation. Methods and Findings: This ecologic study examined clinic attrition rates (total attrition, LTF, and death) among 232,389 patients initiating ART at 349 clinics during 2004–2008 in 10 sub-Saharan African countries, and cohort attrition (proportion retained at 6 and 12 months after ART initiation) among a subset of patients with follow-up information (n = 83,389). Log-linear regression compared mean rates of attrition, LTF, and death between clinics with and without adherence support and outreach services. Cumulative attrition, LTF, and death rates were 14.2, 9.2, and 4.9 per 100 person-years on ART, respectively. In multivariate analyses, clinic availability of >2 adherence support services was marginally associated with lower attrition rates (RRadj = 0.59, 95%CI: 0.35–1.0). Clinics with availability of counseling services (RRadj = 0.62, 95%CI: 0.42–0.92), educational materials (RRadj = 0.73, 95%CI: 0.63–0.85), reminder tools (RRadj = 0.79, 95%CI: 0.64–0.97), and food rations (RRadj = 0.72, 95%CI: 0.58–0.90) had significantly lower attrition, with similar results observed for LTF. Outreach services were not significantly associated with attrition. In cohort analyses, attrition was significantly lower at clinics offering >2 adherence support services (RRadj,6m = 0.84, 95%CI: 0.73–0.96), dedicated pharmacy services (RRadj,6m = 0.78, 95%CI: 0.69–0.90), and active patient outreach (RRadj,6m = 0.85, 95%CI: 0.73–0.99). Availability of food rations was marginally associated with increased retention at 6 (RRadj,6m = 0.82, 95%CI: 0.64–1.05) but not 12 months (RRadj,12m = 0.98, 95%CI: 0.78–1.21). Conclusions: Availability of adherence support services, active patient outreach and food rations at HIV care clinics may improve retention following ART initiation.

Suggested Citation

  • Matthew R Lamb & Wafaa M El-Sadr & Elvin Geng & Denis Nash, 2012. "Association of Adherence Support and Outreach Services with Total Attrition, Loss to Follow-Up, and Death among ART Patients in Sub-Saharan Africa," PLOS ONE, Public Library of Science, vol. 7(6), pages 1-12, June.
    • Handle: RePEc:plo:pone00:0038443
    DOI: 10.1371/journal.pone.0038443
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    References listed on IDEAS

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    1. Ming-Wen An & Constantine E. Frangakis & Beverly S. Musick & Constantin T. Yiannoutsos, 2009. "The Need for Double-Sampling Designs in Survival Studies: An Application to Monitor PEPFAR," Biometrics, The International Biometric Society, vol. 65(1), pages 301-306, March.
    2. Martin W G Brinkhof & Mar Pujades-Rodriguez & Matthias Egger, 2009. "Mortality of Patients Lost to Follow-Up in Antiretroviral Treatment Programmes in Resource-Limited Settings: Systematic Review and Meta-Analysis," PLOS ONE, Public Library of Science, vol. 4(6), pages 1-9, June.
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    1. Ali Safarnejad & Jose-Antonio Izazola-Licea, 2017. "Direct and indirect effects of enablers on HIV testing, initiation and retention in antiretroviral treatment and AIDS related mortality," PLOS ONE, Public Library of Science, vol. 12(2), pages 1-15, February.
    2. Julius Y Fonsah & Alfred K Njamnshi & Charles Kouanfack & Fang Qiu & Dora M Njamnshi & Claude T Tagny & Emilienne Nchindap & Léopoldine Kenmogne & Dora Mbanya & Robert Heaton & Georgette D Kanmogne, 2017. "Adherence to Antiretroviral Therapy (ART) in Yaoundé-Cameroon: Association with Opportunistic Infections, Depression, ART Regimen and Side Effects," PLOS ONE, Public Library of Science, vol. 12(1), pages 1-19, January.

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