Patient retention, clinical outcomes and attrition-associated factors of HIV-infected patients enrolled in Zimbabwe's National Antiretroviral Therapy Programme, 2007-2010.
BACKGROUND
Since establishment of Zimbabwe's National Antiretroviral Therapy (ART) Programme in 2004, ART provision has expanded from <5,000 to 369,431 adults by 2011. However, patient outcomes are unexplored.


OBJECTIVE
To determine improvement in health status, retention and factors associated with attrition among HIV-infected patients on ART.


METHODS
A retrospective review of abstracted patient records of adults ≥ 15 years who initiated ART from 2007 to 2009 was done. Frequencies and medians were calculated for rates of retention in care and changes in key health status outcomes at 6, 12, 24 and 36 months respectively. Cox proportional hazards models were used to determine factors associated with attrition.


RESULTS
Of the 3,919 patients, 64% were female, 86% were either WHO clinical stage III or IV. Rates of patient retention at 6, 12, 24 and 36 months were 90.7%, 78.1%, 68.8% and 64.4%, respectively. After ART initiation, median weight gains at 6, 12, and 24 months were 3, 4.5, and 5.0 kgs whilst median CD4+ cell count gains at 6, 12 and 24 months were 122, 157 and 279 cells/µL respectively. Factors associated with an increased risk of attrition included male gender (AHR 1.2; 95% CI, 1.1-1.4), baseline WHO stage IV (AHR 1.7; 95% CI, 1.1-2.6), lower baseline body weight (AHR 2.0; 95% CI, 1.4-2. 8) and accessing care from higher level healthcare facilities (AHR 3.5; 95% 1.1-11.2).


CONCLUSIONS
Our findings with regard to retention as well as clinical and immunological improvements following uptake of ART, are similar to what has been found in other settings. Factors influencing attrition also mirror those found in other parts of sub-Saharan Africa. These findings suggest the need to strengthen earlier diagnosis and treatment to further improve treatment outcomes. Whilst decentralisation improves ART coverage it should be coupled with strategies aimed at improving patient retention.
AIDS and TB Department, Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe.
Tsitsi
T
Mutasa-Apollo
Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America.
Ray W
RW
Shiraishi
AIDS and TB Department, Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe.
Kudakwashe C
KC
Takarinda
AIDS and TB Department, Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe.
Janet
J
Dzangare
AIDS and TB Department, Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe.
Owen
O
Mugurungi
AIDS and TB Department, Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe.
Joseph
J
Murungu
Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America.
Abu
A
Abdul-Quader
Division of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), Accra, Ghana.
Celia J I
CJ
Woodfill
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D015030:Zimbabwe; D016903:Drug Monitoring
D019380:Anti-HIV Agents