Two-year death and loss to follow-up outcomes by source of referral to HIV care for HIV-infected patients initiating antiretroviral therapy in rural Mozambique.
AUTHORS
- NIHMSID: 8709376
ABSTRACT
Introduction: We studied patient outcomes by type of referral site following two years of combination antiretroviral therapy (cART) during scale-up from June 2006-July 2011 in Mozambique’s rural Zambézia Province. Methods: Loss to follow-up (LTFU) was defined as no contact within 60 days after scheduled medication pickup. Endpoints included LTFU, mortality, and combined mortality/LTFU; we used Kaplan-Meier and cumulative incidence estimates. Referral site was the source of HIV testing. We modeled 2-year outcomes using Cox regression stratified by district, adjusting for sociodemographics and health status. Results: Of 7,615 HIV-infected patients >15 years starting cART, 61% were female and median age was 30 years. Two-year LTFU was 38.1% (95%CI: 36.9-39.3%) and mortality was 14.2% (95%CI 13.2%-15.2%). Patients arrived from voluntary counseling and testing (VCT) sites (51%), general outpatient clinic (21%), antenatal care (8%), inpatient care (3%), HIV/tuberculosis/laboratory facilities (<4%), or other sources of referral (14%). Compared with VCT, patients referred from inpatient, tuberculosis, or antenatal care had higher hazards of LTFU. Adjusted hazard ratios (AHR; 95%CI) for 2-year mortality by referral site (VCT as referent) were: inpatient 1.87 (1.36-2.58), outpatient 1.44 (1.11-1.85), and antenatal care 0.69 (0.43-1.11) and for mortality/LTFU were: inpatient 1.60 (1.34-1.91), outpatient 1.17 (1.02-1.33), tuberculosis care 1.38 (1.08-1.75), and antenatal care 1.24 (1.06-1.44). Discussion: That source of referral was associated with mortality/LTFU after adjusting for patient characteristics at cART initiation suggests that: 1) additional unmeasured factors are influential, and 2) retention programs may benefit from targeting patient populations based on source of referral with focused counseling and/or social support.
Introduction: We studied patient outcomes by type of referral site following two years of combination antiretroviral therapy (cART) during scale-up from June 2006-July 2011 in Mozambique’s rural Zambézia Province. Methods: Loss to follow-up (LTFU) was defined as no contact within 60 days after scheduled medication pickup. Endpoints included LTFU, mortality, and combined mortality/LTFU; we used Kaplan-Meier and cumulative incidence estimates. Referral site was the source of HIV testing. We modeled 2-year outcomes using Cox regression stratified by district, adjusting for sociodemographics and health status. Results: Of 7,615 HIV-infected patients >15 years starting cART, 61% were female and median age was 30 years. Two-year LTFU was 38.1% (95%CI: 36.9-39.3%) and mortality was 14.2% (95%CI 13.2%-15.2%). Patients arrived from voluntary counseling and testing (VCT) sites (51%), general outpatient clinic (21%), antenatal care (8%), inpatient care (3%), HIV/tuberculosis/laboratory facilities (<4%), or other sources of referral (14%). Compared with VCT, patients referred from inpatient, tuberculosis, or antenatal care had higher hazards of LTFU. Adjusted hazard ratios (AHR; 95%CI) for 2-year mortality by referral site (VCT as referent) were: inpatient 1.87 (1.36-2.58), outpatient 1.44 (1.11-1.85), and antenatal care 0.69 (0.43-1.11) and for mortality/LTFU were: inpatient 1.60 (1.34-1.91), outpatient 1.17 (1.02-1.33), tuberculosis care 1.38 (1.08-1.75), and antenatal care 1.24 (1.06-1.44). Discussion: That source of referral was associated with mortality/LTFU after adjusting for patient characteristics at cART initiation suggests that: 1) additional unmeasured factors are influential, and 2) retention programs may benefit from targeting patient populations based on source of referral with focused counseling and/or social support.
Tags: Faculty Publications 2014