Status of Patients Retention Into HIV Care Following Implementation of Multi-month Scripting For Antiretrovirals In Mwanza, Tanzania, 2018–2020
- Viral hepatitis and HIV
- Sexually Transmitted Diseases
Background: The HIV/AIDS epidemic is still a public health threat and a leading cause of morbidity and mortality in Tanzania while retaining patients into HIV care programs is still a challenge. It is speculated that the problem may become worse with the antiretroviral therapy (ART) multi-month prescription strategy due to the increased intervals between clinical visits. We studied the status of HIV patient retention into care following implementation of ART MMS in Mwanza.
Methods: A retrospective open cohort study using secondary data from CTC 3 macro database for patients received ART was conducted in Mwanza between June 2018–June 2020. The main outcome was patient retention to HIV care. Kaplan Meier plots were constructed and compared with the log rank-test. The cox proportional hazards regression adjusted for potential confounders associated with patient retention into HIV care.
Results: Of the 21,742 patients included in the analysis, 14,064 (64.6%) were female, median age and IQR was 35.9±16.7 years and 11,986 (55.1%) were married. The majority of patients 18,401 (85.5%) received care from public health facilities and 12,573 (57.8 %) had WHO clinical stage I disease. Probabilities of retention into HIV care were higher among HIV patients kept in ART MMS as compared to non-MMS group (log rank χ2 =330.7,p<0.001) and median survival times were 14 (95% CI=13.9–14.2) and 11 (95% CI=10.9–11.4) months respectively. Factors associated with attrition included non-MMS (adjusted hazard ratio (aHR) 1.40; 95% CI=1.35–1.45,p < 0.001), being single (aHR=1.05; 95% CI=1.02–1.09, p =0.002), and young age (15–24 years) (aHR=1.21; 95% CI=0.90–1.32, p <0.001).
Conclusions: Retaining HIV-stable patients into care has been achieved using the ART MMS strategy. Improvements in retention to care among stable HIV patients may further be attained by addressing challenges hindering patients at 15–24 years. Health care providers should adhere to the guidelines and keep eligible patients in ART MMS.
Methods: A retrospective open cohort study using secondary data from CTC 3 macro database for patients received ART was conducted in Mwanza between June 2018–June 2020. The main outcome was patient retention to HIV care. Kaplan Meier plots were constructed and compared with the log rank-test. The cox proportional hazards regression adjusted for potential confounders associated with patient retention into HIV care.
Results: Of the 21,742 patients included in the analysis, 14,064 (64.6%) were female, median age and IQR was 35.9±16.7 years and 11,986 (55.1%) were married. The majority of patients 18,401 (85.5%) received care from public health facilities and 12,573 (57.8 %) had WHO clinical stage I disease. Probabilities of retention into HIV care were higher among HIV patients kept in ART MMS as compared to non-MMS group (log rank χ2 =330.7,p<0.001) and median survival times were 14 (95% CI=13.9–14.2) and 11 (95% CI=10.9–11.4) months respectively. Factors associated with attrition included non-MMS (adjusted hazard ratio (aHR) 1.40; 95% CI=1.35–1.45,p < 0.001), being single (aHR=1.05; 95% CI=1.02–1.09, p =0.002), and young age (15–24 years) (aHR=1.21; 95% CI=0.90–1.32, p <0.001).
Conclusions: Retaining HIV-stable patients into care has been achieved using the ART MMS strategy. Improvements in retention to care among stable HIV patients may further be attained by addressing challenges hindering patients at 15–24 years. Health care providers should adhere to the guidelines and keep eligible patients in ART MMS.