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. 2012;7(7):e40971.
doi: 10.1371/journal.pone.0040971. Epub 2012 Jul 17.

Retention in a NGO supported antiretroviral program in the Democratic Republic of Congo

Olivier Koole  1 , Lucien Kalenga, Modeste Kiumbu, Joris Menten, Robert W Ryder, Henri Mukumbi, Robert Colebunders
Affiliations

Retention in a NGO supported antiretroviral program in the Democratic Republic of Congo

Olivier Koole et al. PLoS One. 2012.

Abstract

Background: Retention of patients in ART care is a major challenge in sub-Saharan programs. Retention is also one of the key indicators to evaluate the success of ART programs.

Methods and findings: A retrospective review of 1500 randomly selected medical charts of adult ART patients from a local non-governmental (NGO) supported ART program in the Democratic Republic of Congo (DRC). Retention was defined as any visit to the clinic in the 4 months prior to the abstraction date. Retention over time and across different sites was described. The relationship between patient characteristics and retention rates at 1 year was also examined. 1450 patients were included in the analysis. The overall retention rates were 81.4% (95% CI: 79.3-83.4), 75.2% (95% CI: 72.8-77.3), 65.0% (95% CI: 62.3-67.6) and 57.2% (95% CI: 54.0-60.3) at 6 months, 1 year, 2 years and 3 years respectively. The retention rates between sites varied between 62.1% and 90.6% at 6 months and between 55.5% and 86.2% at 1 year. During multivariable analysis weight below 50 kg (aHR: 1.33, 95%CI: 1.05-1.69), higher WHO stage at initiation (aHR: 1.22, 95%CI 0.85-1.76 for stage 3 and aHR: 2.98, 95%CI: 1.93-4.59 for stage 4), and male sex (aHR: 1.32, 95%CI: 1.05-1.65) remained as significant risk factors for attrition during the first year after ART initiation. Other independent risk factors were year of initiation (aHR: 1.73, 95%CI: 1.26-2.38 for the year 2007 and aHR: 3.06, 95%CI: 2.26-4.14 for the period 2008-2009), and site.

Conclusions: Retention is a major problem in DRC, while coverage of patients on ART is still very low. With the flattening of funding for HIV care and treatment in sub-Saharan Africa, and with decreasing funding worldwide, maximizing retention during the much needed scaling-up will even be more important.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Map of Democratic Republic of Congo with localization of the study sites.
Figure 2
Figure 2. Flow chart of the study process.
Figure 3
Figure 3. Proportion of patients discontinuing from the AmoCongo ART program over time.
Figure 4
Figure 4. Proportion of patients discontinuing from the AmoCongo ART program at 1 year by the 6 study sites.
Figure 5
Figure 5. Probability of discontinuing from the AmoCongo ART program at 1 year over time by calendar year.
See this image and copyright information in PMC

References

    1. WHO. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector. Progress report 2010. WHO website. 2010. Available: http://whqlibdoc.who.int/publications/2010/9789241500395_eng.pdf. Accessed: 2011 Nov 8.
    1. Rosen S, Fox MP, Gill CJ. Patient retention in antiretroviral therapy programs in sub-Saharan Africa: a systematic review. PLoS Med 4: e298. PLoS Medicine website. 2007. Available: http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0040298. Accessed: 2011 Nov 8. - DOI - PMC - PubMed
    1. Yu JK, Chen SC, Wang KY, Chang CS, Makombe SD, et al. True outcomes for patients on antiretroviral therapy who are “lost to follow-up” in Malawi. Bull World Health Organ 85: 550–554. WHO website. 2007. Available: http://www.who.int/bulletin/volumes/85/7/06-037739.pdf. Accessed: 2011 Nov 8. - PMC - PubMed
    1. Bisson GP, Gaolathe T, Gross R, Rollins C, Bellamy S, et al. Overestimates of survival after HAART: implications for global scale-up efforts. PLoS ONE 3: e1725. PLoS ONE website. 2008. Available: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0001725. Accessed: 2011 Nov 8. - PMC - PubMed
    1. Giordano TP, Gifford AL, White AC, Jr, Suarez-Almazor ME, Rabeneck L, et al. Retention in care: a challenge to survival with HIV infection. Clin Infect Dis. 2007;44:1493–1499. - PubMed

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