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. 2013 Apr 15;62(5):e146-52.
doi: 10.1097/QAI.0b013e3182840d4e.

Integration of HIV care and treatment in primary health care centers and patient retention in central Mozambique: a retrospective cohort study

Barrot H Lambdin  1 , Mark A Micek, Kenneth Sherr, Sarah Gimbel, Marina Karagianis, Joseph Lara, Stephen S Gloyd, James Pfeiffer
Affiliations

Integration of HIV care and treatment in primary health care centers and patient retention in central Mozambique: a retrospective cohort study

Barrot H Lambdin et al. J Acquir Immune Defic Syndr. .

Abstract

Background: In 2004, the Mozambican Ministry of Health began a national scale-up of antiretroviral therapy (ART) using a vertical model of HIV clinics colocated within large urban hospitals. In 2006, the ministry expanded access by integrating ART into primary health care clinics.

Methods: We conducted a retrospective cohort study including adult ART-naive patients initiating ART between January 2006 and June 2008 in public sector clinics in Manica and Sofala provinces. Cox proportional hazards models with robust variances were used to estimate the association between clinic model (vertical/integrated), clinic location (urban/rural), and clinic experience (first 6 months/post first 6 months) and attrition occurring in early patient follow-up (≤ 6 months) and attrition occurring in late patient follow-up (>6 months), while controlling for age, sex, education, pre-ART CD4 count, World Health Organization stage and pharmacy staff burden.

Results: A total of 11,775 patients from 17 clinics were studied. The overall attrition rate was 37 per 100 person-years. Patients attending integrated clinics had a higher risk of attrition in late follow-up [hazard ratio (HR) = 1.75; 95% confidence interval (CI): 1.04 to 2.94], and patients attending urban clinics (HR = 0.57; 95% CI: 0.35 to 0.91) had a lower risk of attrition in late follow-up. Though not statistically significant, clinics open for longer than 6 months (HR = 0.71; 95% CI: 0.49 to 1.04) had a lower risk of attrition in early follow-up.

Conclusions: Patients attending vertical clinics had a lower risk of attrition. Utilizing primary health clinics to implement ART is necessary to reach higher levels of coverage; however, further implementation strategies should be developed to improve patient retention in these settings.

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Figures

FIGURE 1
FIGURE 1
The cumulative number of ART-naive adult patients initiating treatment by clinic type during the study period.
FIGURE 2
FIGURE 2
Retention probability of patients receiving HIV treatment at integrated and vertical clinics for attrition occurring during the first 6 months of patient follow-up (A) and attrition occurring after the first 6 months of patient follow-up (B).
See this image and copyright information in PMC

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