title: Facility-Level Factors Influencing Retention of Patients in HIV Care in East Africa.
abstract: Losses to follow-up (LTFU) remain an important programmatic challenge. While numerous patient-level factors have been associated with LTFU, less is known about facility-level factors. Data from the East African International epidemiologic Databases to Evaluate AIDS (EA-IeDEA) Consortium was used to identify facility-level factors associated with LTFU in Kenya, Tanzania and Uganda. Patients were defined as LTFU if they had no visit within 12 months of the study endpoint for pre-ART patients or 6 months for patients on ART. Adjusting for patient factors, shared frailty proportional hazard models were used to identify the facility-level factors associated with LTFU for the pre- and post-ART periods. Data from 77,362 patients and 29 facilities were analyzed. Median age at enrolment was 36.0 years (Interquartile Range: 30.1, 43.1), 63.9% were women and 58.3% initiated ART. Rates (95% Confidence Interval) of LTFU were 25.1 (24.7-25.6) and 16.7 (16.3-17.2) per 100 person-years in the pre-ART and post-ART periods, respectively. Facility-level factors associated with increased LTFU included secondary-level care, HIV RNA PCR turnaround time >14 days, and no onsite availability of CD4 testing. Increased LTFU was also observed when no nutritional supplements were provided (pre-ART only), when TB patients were treated within the HIV program (pre-ART only), and when the facility was open ≤4 mornings per week (ART only). Our findings suggest that facility-based strategies such as point of care laboratory testing and separate clinic spaces for TB patients may improve retention.
authors: The Ontario HIV Treatment Network, Toronto, Canada.|Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
authors: Beth
authors: B
authors: Rachlis
authors: Department of Biostatistics, Richard Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, United States of America.
authors: Giorgos
authors: G
authors: Bakoyannis
authors: Infectious Diseases Institute, Kampala, Uganda.
authors: Philippa
authors: P
authors: Easterbrook
authors: Department of Health Services, Brown University, Providence, Rhode Island, United States of America.
authors: Becky
authors: B
authors: Genberg
authors: Department of Population Health, School of Medicine, New York University, New York, New York, United States of America.
authors: Ronald Scott
authors: RS
authors: Braithwaite
authors: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America.
authors: Craig R
authors: CR
authors: Cohen
authors: Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors: Elizabeth A
authors: EA
authors: Bukusi
authors: Infectious Diseases Institute, Kampala, Uganda.
authors: Andrew
authors: A
authors: Kambugu
authors: Department of Internal Medicine, Mbarara University of Science & Technology, Mbarara, Uganda.
authors: Mwebesa Bosco
authors: MB
authors: Bwana
authors: National AIDS Control Programme, Dar es Salaam, Tanzania.
authors: Geoffrey R
authors: GR
authors: Somi
authors: Department of Medicine, University of California San Francisco, San Francisco, California, United States of America.
authors: Elvin H
authors: EH
authors: Geng
authors: Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America.
authors: Beverly
authors: B
authors: Musick
authors: Department of Biostatistics, Richard Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, United States of America.
authors: Constantin T
authors: CT
authors: Yiannoutsos
authors: Division of Infectious Diseases, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America.
authors: Kara
authors: K
authors: Wools-Kaloustian
authors: Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya.|Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.|Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
authors: Paula
authors: P
authors: Braitstein
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D016208:Databases, Factual; D003695:Delivery of Health Care / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006678:HIV / Q000235:genetics / Q000302:isolation & purification; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality / Q000628:therapy* / Q000821:virology; D006268:Health Facilities / Q000592:standards* / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007630:Kenya; D059012:Lost to Follow-Up; D008297:Male; D016016:Proportional Hazards Models; D012367:RNA, Viral / Q000378:metabolism; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013636:Tanzania; D014454:Uganda
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral