title: Survival of people on antiretroviral treatment in Zambia: a retrospective cohort analysis of HIV clients on ART.
abstract: BACKGROUND
  Provision of free anti-retroviral therapy in Zambia started in June 2004. There were only 15,000 people on treatment as at December that year, mainly due to lack of access. This number rose to 580,000 people as at December 2013. The general objective of this study was to determine survival of people on ART and to examine associated predictors for survival.
  
  
  METHODS
  The study included ART patients enrolled between the year 2002 and 2013 (n=10,395) in 285 health facilities in Zambia. Patient files were analyzed retrospectively. The study used Kaplan Meier and Cox-proportional hazard models to describe the relationship between lost to follow up and age, sex, baseline CD4 cell count and weight.
  
  
  RESULTS
  Results showed that lost to follow up accounted for 90% of the clients that had dropped out, while 10% was to deaths. Low baseline CD4 count (p-value 0.001, HR 0.9994, (95% CI 0.9993, 0.9996) at initiation was associated with lost to follow up together with weight at initiation (p-value 0.031, HR 0.9987 at 95% CI (0.9975, 0.9998)) of ART.
  
  
  CONCLUSIONS
  This study has demonstrated that lost to follow up is a substantial contributing factor to drop outs among HIV patients on treatment. Strengthening of community treatment supporters especially immediate family members in emphasizing to the client the need to continue treatment is necessary. The health facility could do more in emphasizing the importance of treatment especially in the initial stages. Further, in order to reduce opportunistic infections and probable deaths during treatment, cotrimoxazole prophylaxis should be maintained so as to raise the CD4 levels. Improved nutritional assessment and counseling to boost the nutritional status of the clients throughout should be encouraged.
authors.affiliation: University of Zambia, School of Medicine, Department of Public Health; Ministry of health, Zambia.
authors.forename: Patrick
authors.initials: P
authors.lastname: Amanzi
authors.affiliation: University of Zambia, School of Medicine, Department of Public Health.
authors.forename: Charles
authors.initials: C
authors.lastname: Michelo
authors.affiliation: Ministry of health, Zambia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Simoonga
authors.affiliation: University of Zambia, School of Medicine, Department of Public Health.
authors.forename: Rosalia
authors.initials: R
authors.lastname: Dambe
authors.affiliation: University of Zambia, School of Medicine, Department of Public Health.
authors.forename: Gershom
authors.initials: G
authors.lastname: Chongwe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D059012:Lost to Follow-Up; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013534:Survival; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage; D055815:Young Adult; D015024:Zambia
chemical_list: D019380:Anti-HIV Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: Survival analysis; lost to follow up; retrospective cohort