title: Retrospective study on the critical factors for retaining patients on antiretroviral therapy in KwaZulu-Natal, South Africa.
abstract: OBJECTIVE
  To analyze the critical factors favoring the retention of patients under antiretroviral therapy (ART) in KwaZulu-Natal (KZN), South Africa.
  
  
  METHODS
  This retrospective study was based on the review of a representative sample of patients who began ART between March 2004 and May 2006 in 32 public sector sites and were followed up to July 1, 2007. Extended Cox proportional hazard models were used to identify the factors which significantly influenced treatment retention during the first 2 years of treatment. Kaplan-Meyer provided the probabilities of remaining on ART if these factors were present.
  
  
  RESULTS
  The 2835 sampled patients corresponded to about 10% of the universe of patients under ART in the 32 sites; 929 (33%) were males, and the median age of the sampled patients was 34 (interquartile range: 28-41). The analysis identified factors that significantly decreased the probability of remaining on ART. Patients' risk factors were initial CD4 <100 cells per microliter, lack of a telephone contact number, and being male. Sites' risk factors were the presence of a part time (PT) versus a full time (FT) senior professional nurse, a PT versus FT doctor, and intakes of 200 or more new patients per doctor per year. The probability of remaining on ART declined significantly for each increasing level of workload, but having a FT versus a PT doctor made a significant difference only for level of workload of 200 or more new patients per year.
  
  
  CONCLUSIONS
  The analysis has identified the conditions influencing retention of ART patients in KZN. This has provided a method to estimate absorption capacity of the ART delivery sites, which is of added value for a sustainable expansion of the ART coverage.
authors.affiliation: Department of Health, Italian Cooperation, Pietermaritzburg, KwaZulu-Natal, South Africa. thevellas@yahoo.it
authors.forename: Venanzio
authors.initials: V
authors.lastname: Vella
authors.forename: Thiloshini
authors.initials: T
authors.lastname: Govender
authors.forename: Sicelo
authors.initials: S
authors.lastname: Dlamini
authors.forename: Myra
authors.initials: M
authors.lastname: Taylor
authors.forename: Indres
authors.initials: I
authors.lastname: Moodley
authors.forename: Verona
authors.initials: V
authors.lastname: David
authors.forename: Champaklal
authors.initials: C
authors.lastname: Jinabhai
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001291:Attitude of Health Personnel; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents