title: Retention and risk factors for attrition in a large public health ART program in Myanmar: a retrospective cohort analysis.
abstract: BACKGROUND
  The outcomes from an antiretroviral treatment (ART) program within the public sector in Myanmar have not been reported. This study documents retention and the risk factors for attrition in a large ART public health program in Myanmar.
  
  
  METHODS
  A retrospective analysis of a cohort of adult patients enrolled in the Integrated HIV Care (IHC) Program between June 2005 and October 2011 and followed up until April 2012 is presented. The primary outcome was attrition (death or loss-follow up); a total of 10,223 patients were included in the 5-year cumulative survival analysis. Overall 5,718 patients were analyzed for the risk factors for attrition using both logistic regression and flexible parametric survival models.
  
  
  RESULTS
  The mean age was 36 years, 61% of patients were male, and the median follow up was 13.7 months. Overall 8,564 (84%) patients were retained in ART program: 750 (7%) were lost to follow-up and 909 (9%) died. During the 3 years follow-up, 1,542 attritions occurred over 17,524 person years at risk, giving an incidence density of 8.8% per year. The retention rates of participants at 12, 24, 36, 48 and 60 months were 86, 82, 80, 77 and 74% respectively. In multivariate analysis, being male, having high WHO staging, a low CD4 count, being anaemic or having low BMI at baseline were independent risk factors for attrition; tuberculosis (TB) treatment at ART initiation, a prior ART course before program enrollment and literacy were predictors for retention in the program.
  
  
  CONCLUSIONS
  High retention rate of IHC program was documented within the public sector in Myanmar. Early diagnosis of HIV, nutritional support, proper investigation and treatment for patients with low CD4 counts and for those presenting with anaemia are crucial issues towards improvement of HIV program outcomes in resource-limited settings.
authors.affiliation: The Union Office in Myanmar, International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar.
authors.forename: Aye
authors.initials: A
authors.lastname: Thida
authors.affiliation: The Union Office in Myanmar, International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar.
authors.forename: Sai Thein Than
authors.initials: ST
authors.lastname: Tun
authors.affiliation: The Union Office in Myanmar, International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar.
authors.forename: Sai Ko Ko
authors.initials: SK
authors.lastname: Zaw
authors.affiliation: Infectious Diseases Programme, Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Lover
authors.affiliation: Innovation Unit, Médecins Sans Frontières, Geneva, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Cavailler
authors.affiliation: Maths and Statistics Help Centre, James Cook University, Singapore.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chunn
authors.affiliation: Medical Care Division, Department of Health, Mandalay, Myanmar.
authors.forename: Mar Mar
authors.initials: MM
authors.lastname: Aye
authors.affiliation: Medical Care Division, Department of Health, Mandalay, Myanmar.
authors.forename: Par
authors.initials: P
authors.lastname: Par
authors.affiliation: Medical Care Division, Department of Health, Mandalay, Myanmar.
authors.forename: Kyaw Win
authors.initials: KW
authors.lastname: Naing
authors.affiliation: Medical Care Division, Department of Health, Mandalay, Myanmar.
authors.forename: Kaung Nyunt
authors.initials: KN
authors.lastname: Zan
authors.affiliation: National AIDS Program, Department of Health, Nay Pyi Taw, Myanmar.
authors.forename: Myint
authors.initials: M
authors.lastname: Shwe
authors.affiliation: Disease Control Division, Department of Health, Nay Pyi Taw, Myanmar.
authors.forename: Thar Tun
authors.initials: TT
authors.lastname: Kyaw
authors.affiliation: The Union Office in Myanmar, International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar.
authors.forename: Zaw Htoon
authors.initials: ZH
authors.lastname: Waing
authors.affiliation: The Union Office in Myanmar, International Union Against Tuberculosis and Lung Disease, Mandalay, Myanmar.
authors.forename: Philippe
authors.initials: P
authors.lastname: Clevenbergh
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology* / Q000821:virology; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D002052:Myanmar / Q000453:epidemiology; D009313:National Health Programs / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D011634:Public Health / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents