Socioeconomic support reduces nonretention in a comprehensive, community-based antiretroviral therapy program in Uganda.
OBJECTIVE
We evaluated the benefit of socioeconomic support (S-E support), comprising various financial and nonfinancial services that are available based on assessment of need, in reducing mortality and lost to follow-up (LTFU) at Reach Out Mbuya, a community-based, antiretroviral therapy program in Uganda.


METHODS
Retrospective observational cohort data from adult patients enrolled between May 31, 2001, and May 31, 2010, were examined.


METHODS
Patients were categorized into none, 1, and 2 or more S-E support based on the number of different S-E support services they received. Using Cox proportional hazards regression, we modeled the association between S-E support and mortality or LTFU. Kaplan-Meier curves were fitted to examine retention functions stratified by S-E support.


RESULTS
In total, 6654 patients were evaluated. After 10 years, 2700 (41%) were retained. Of the 3954 not retained, 2933 (74%) were LTFU and 1021 (26%) had died. After 1, 2, 5, and 10 years, the risks of LTFU or mortality in patients who received no S-E support were significantly higher than those who received some S-E support. In adjusted hazards ratios, patients who received no S-E support were 1.5-fold (1.39-1.64) and 6.7-fold (5.56-7.69) more likely to get LTFU compared with those who received 1 or ≥ 2 S-E support, respectively. Likewise, patients who received no S-E support were 1.5-fold (confidence interval: 1.16 to 1.89) and 4.3-fold (confidence interval: 2.94 to 6.25) more likely to die compared with those who received 1 or 2+ S-E support, respectively.


CONCLUSIONS
Provision of S-E support reduced LTFU and mortality, suggesting the value of incorporating such strategies for promoting continuity of care.
Medical Department, Reach Out Mbuya HIV/AIDS Initiative, Kampala, Uganda. stellaalamo@gmail.com
Stella
S
Talisuna-Alamo
Robert
R
Colebunders
Joseph
J
Ouma
Pamela
P
Sunday
Kenneth
K
Ekoru
Marie
M
Laga
Glenn
G
Wagner
Fred
F
Wabwire-Mangen
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality / Q000523:psychology*; D006801:Humans; D015994:Incidence; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012944:Social Support; D016896:Treatment Outcome; D014454:Uganda; D055815:Young Adult
D019380:Anti-HIV Agents