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. 2012;7(12):e51254.
doi: 10.1371/journal.pone.0051254. Epub 2012 Dec 13.

The pattern of attrition from an antiretroviral treatment program in Nigeria

Solomon Odafe  1 , Kwasi Torpey, Hadiza Khamofu, Obinna Ogbanufe, Edward A Oladele, Oluwatosin Kuti, Oluwasanmi Adedokun, Titilope Badru, Emeka Okechukwu, Otto Chabikuli
Affiliations

The pattern of attrition from an antiretroviral treatment program in Nigeria

Solomon Odafe et al. PLoS One. 2012.

Abstract

Objective: To evaluate the rate and factors associated with attrition of patients receiving ART in tertiary and secondary hospitals in Nigeria.

Methods and findings: We reviewed patient level data collected between 2007 and 2010 from 11 hospitals across Nigeria. Kaplan-Meier product-limit and Cox regression were used to determine probability of retention in care and risk factors for attrition respectively. Of 6,408 patients in the cohort, 3,839 (59.9%) were females, median age of study population was 33years (IQR: 27-40) and 4,415 (69%) were from secondary health facilities. The NRTI backbone was Stavudine (D4T) in 3708 (57.9%) and Zidovudine (ZDV) in 2613 (40.8%) of patients. Patients lost to follow up accounted for 62.7% of all attrition followed by treatment stops (25.3%) and deaths (12.0%). Attrition was 14.1 (N = 624) and 15.1% (N = 300) in secondary and tertiary hospitals respectively (p = 0.169) in the first 12 months on follow up. During the 13 to 24 months follow up period, attrition was 10.7% (N = 407) and 19.6% (N = 332) in secondary and tertiary facilities respectively (p<0.001). Median time to lost to follow up was 11.1 (IQR: 6.1 to 18.5) months in secondary compared with 13.6 (IQR: 9.9 to 17.0) months in tertiary sites (p = 0.002). At 24 months follow up, male gender [AHR 1.18, 95% CI: 1.01-1.37, P = 0.038]; WHO clinical stage III [AHR 1.30, 95%CI: 1.03-1.66, P = 0.03] and clinical stage IV [AHR 1.90, 95%CI: 1.20-3.02, p = 0.007] and care in a tertiary hospital [AHR 2.21, 95% CI: 1.83-2.67, p<0.001], were associated with attrition.

Conclusion: Attrition could potentially be reduced by decentralizing patients on ART after the first 12 months on therapy to lower level facilities, earlier initiation on treatment and strengthening adherence counseling amongst males.

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Conflict of interest statement

Competing Interests: All authors declare that they have no financial or non financial competing interests that may be related to this study. One of the authors worked briefly for a research consultancy firm (Diadem Consult Ltd). However this does not alter the authors' adherence to all of PLOS ONE policies on sharing data and materials. The authors attest that they have no affiliations that would have influenced outcomes of this paper and that there were no infringement on copyrights or any other conflicts with regards this manuscript.

Figures

Figure 1
Figure 1. Kaplan-Meier curve showing retention in care for 24 months in secondary and tertiary facilities.
(Breslow-Gehan test χ2 = 24.4; p<0.001).
See this image and copyright information in PMC

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