Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared

Labhardt, Niklaus Daniel; Keiser, Olivia; Sello, Motlalepula; Lejone, Thabo Ishmael; Pfeiffer, Karolin; Davies, Mary-Ann; Egger, Matthias; Ehmer, Jochen; Wandeler, Gilles (2013). Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared. Journal of the International AIDS Society, 16, p. 18616. BioMed Central 10.7448/IAS.16.1.18616

[img]
Preview
Text
Labhardt JIntAIDSSoc 2013.pdf - Published Version
Available under License Creative Commons: Attribution (CC-BY).

Download (365kB) | Preview
[img]
Preview
Image
Labhardt JIntAIDSSoc 2013_supplfigure1.pdf - Additional Metadata
Available under License Creative Commons: Attribution (CC-BY).

Download (57kB) | Preview
[img]
Preview
Image
Labhardt JIntAIDSSoc 2013_webtable1.pdf - Additional Metadata
Available under License Creative Commons: Attribution (CC-BY).

Download (97kB) | Preview

Introduction: Lesotho was among the first countries to adopt decentralization of care from hospitals to nurse-led health centres (HCs) to scale up the provision of antiretroviral therapy (ART). We compared outcomes between patients who started ART at HCs and hospitals in two rural catchment areas in Lesotho. Methods: The two catchment areas comprise two hospitals and 12 HCs. Patients ≥16 years starting ART at a hospital or HC between 2008 and 2011 were included. Loss to follow-up (LTFU) was defined as not returning to the facility for ≥180 days after the last visit, no follow-up (no FUP) as not returning after starting ART, and retention in care as alive and on ART at the facility. The data were analysed using logistic regression, competing risk regression and Kaplan-Meier methods. Multivariable analyses were adjusted for sex, age, CD4 cell count, World Health Organization stage, catchment area and type of ART. All analyses were stratified by gender. Results: Of 3747 patients, 2042 (54.5%) started ART at HCs. Both women and men at hospitals had more advanced clinical and immunological stages of disease than those at HCs. Over 5445 patient-years, 420 died and 475 were LTFU. Kaplan-Meier estimates for three-year retention were 68.7 and 69.7% at HCs and hospitals, respectively, among women (p=0.81) and 68.8% at HCs versus 54.7% at hospitals among men (p<0.001). These findings persisted in adjusted analyses, with similar retention at HCs and hospitals among women (odds ratio (OR): 0.89, 95% confidence interval (CI): 0.73-1.09) and higher retention at HCs among men (OR: 1.53, 95% CI: 1.20-1.96). The latter result was mainly driven by a lower proportion of patients LTFU at HCs (OR: 0.68, 95% CI: 0.51-0.93). Conclusions: In rural Lesotho, overall retention in care did not differ significantly between nurse-led HCs and hospitals. However, men seemed to benefit most from starting ART at HCs, as they were more likely to remain in care in these facilities compared to hospitals.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Keiser, Olivia; Egger, Matthias and Wandeler, Gilles

Subjects:

300 Social sciences, sociology & anthropology > 360 Social problems & social services
600 Technology > 610 Medicine & health

ISSN:

1758-2652

Publisher:

BioMed Central

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

06 Mar 2014 19:20

Last Modified:

12 Sep 2017 06:35

Publisher DOI:

10.7448/IAS.16.1.18616

PubMed ID:

24267671

Additional Information:

Labhardt and Wandeler contributed equally to this work.

Uncontrolled Keywords:

antiretroviral treatment, decentralization, rural Southern Africa, retention in care, task shifting, nurse-based care, HIV

BORIS DOI:

10.7892/boris.41420

URI:

https://boris.unibe.ch/id/eprint/41420

Actions (login required)

Edit item Edit item
Provide Feedback