title: Retention among ART patients in the Highlands of Papua New Guinea: evaluating the PAPUA model.
abstract: BACKGROUND
  Despite more than 10,000 patients on antiretroviral therapy (ART), there remains a dearth of operational research in Papua New Guinea related to HIV service delivery. This study examined the effectiveness of a locally developed model of HIV service delivery called PAPUA (Patient and Provider Unified Approach) in the Highlands of Papua New Guinea. The model emphasizes coordinated patient and provider support along with decentralized services to rural districts in the Highlands.
  
  
  METHODS
  We conducted a chart review among HIV-infected adults on ART at clinics in Eastern Highlands Province, where the PAPUA model was implemented in addition to the standard of care, and in Western Highlands Province, where the standard of care was implemented. We calculated yearly retention rates and used multivariable Cox proportional hazards regression analyses to compare retention rates across the provinces.
  
  
  RESULTS
  Data for 2457 patients from the 2 provinces were analyzed. Among patients receiving ART under the PAPUA model in Eastern Highlands, the 12-, 24-, 36-, and 48-month retention proportions were 0.79, 0.73, 0.68, and 0.63, respectively. When we compared retention probabilities across the 2 provinces, patients receiving care under the PAPUA model had a 15% lower rate of attrition from care during the first 4 years of ART (hazard ratio, 0.85; 95% confidence interval: 0.74 to 0.99; P = 0.03), after adjusting for age, gender, and year of enrollment.
  
  
  CONCLUSIONS
  The PAPUA model seems to be a promising intervention although it is inextricably linked to the limitations posed by a resource-constrained health system.
authors.affiliation: *Clinton Health Access Initiative, Goroka, Papua New Guinea; †Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA; and ‡National Department of Health, Highlands Region, Papua New Guinea.
authors.forename: Sarthak
authors.initials: S
authors.lastname: Das
authors.forename: Andy
authors.initials: A
authors.lastname: Carmone
authors.forename: Molly F
authors.initials: MF
authors.lastname: Franke
authors.forename: Dale
authors.initials: D
authors.lastname: Frank
authors.forename: Hannelly
authors.initials: H
authors.lastname: Kiromat
authors.forename: Petronia
authors.initials: P
authors.lastname: Kaima
authors.forename: Mobumo
authors.initials: M
authors.lastname: Kiromat
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010219:Papua New Guinea; D016903:Drug Monitoring
chemical_list: D044966:Anti-Retroviral Agents