Socioeconomic support reduces nonretention in a comprehensive, community-based antiretroviral therapy program in Uganda

Abstract

Objectives: We evaluated the benefit of socioeconomic support (S-E support), comprising various financial and nonfinancial services that are available based on assessment of need, in reducing mortality and lost to follow-up (LTFU) at Reach Out Mbuya, a community-based, antiretroviral therapy program in Uganda.

Design: Retrospective observational cohort data from adult patients enrolled between May 31, 2001, and May 31, 2010, were examined.

Methods: Patients were categorized into none, 1, and 2 or more S-E support based on the number of different S-E support services they received. Using Cox proportional hazards regression, we modeled the association between S-E support and mortality or LTFU. Kaplan-Meier curves were fitted to examine retention functions stratified by S-E support.

Results: In total, 6654 patients were evaluated. After 10 years, 2700 (41%) were retained. Of the 3954 not retained, 2933 (74%) were LTFU and 1021 (26%) had died. After 1, 2, 5, and 10 years, the risks of LTFU or mortality in patients who received no S-E support were significantly higher than those who received some S-E support. In adjusted hazards ratios, patients who received no S-E support were 1.5-fold (1.39-1.64) and 6.7-fold (5.56-7.69) more likely to get LTFU compared with those who received 1 or ≥ 2 S-E support, respectively. Likewise, patients who received no S-E support were 1.5-fold (confidence interval: 1.16 to 1.89) and 4.3-fold (confidence interval: 2.94 to 6.25) more likely to die compared with those who received 1 or 2+ S-E support, respectively.

Conclusions: Provision of S-E support reduced LTFU and mortality, suggesting the value of incorporating such strategies for promoting continuity of care.

FIGURE 1

Flow chart of patients enrolled at the ROM HIV/AIDS Initiative clinics between May 31, 2001, and May 31, 2010.

FIGURE 2

Retention benefits of S-E support on survival in ROM (A) Kaplan–Meier plot showing probability of not getting LTFU stratified by S-E support (n = 2933). B, Kaplan–Meier plot showing probability of survival stratified by S-E support (n = 1021).