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. 2016 Jan;21(1):18-27.
doi: 10.1111/tmi.12623. Epub 2015 Nov 12.

Variation in attrition at subnational level: review of the Botswana National HIV/AIDS Treatment (Masa) programme data (2002-2013)

Mansour Farahani  1 , Natalie Price  1 , Shenaaz El-Halabi  2 , Naledi Mlaudzi  2 , Koona Keapoletswe  2 , Refeletswe Lebelonyane  2 , Ernest Benny Fetogang  2 , Tony Chebani  2 , Poloko Kebaabetswe  3 , Tiny Masupe  3 , Keba Gabaake  3 , Andrew Auld  4 , Oathokwa Nkomazana  3 , Richard Marlink  1
Affiliations

Variation in attrition at subnational level: review of the Botswana National HIV/AIDS Treatment (Masa) programme data (2002-2013)

Mansour Farahani et al. Trop Med Int Health. 2016 Jan.

Abstract

Objective: To evaluate the variation in all-cause attrition [mortality and loss to follow-up (LTFU)] among HIV-infected individuals in Botswana by health district during the rapid and massive scale-up of the National Treatment Program.

Methods: Analysis of routinely collected longitudinal data from 226 030 patients who received ART through the Botswana National HIV/AIDS Treatment Program across all 24 health districts from 2002 to 2013. A time-to-event analysis was used to measure crude mortality and loss to follow-up rates (LTFU). A marginal structural model was used to evaluate mortality and LTFU rates by district over time, adjusted for individual-level risk factors (e.g. age, gender, baseline CD4, year of treatment initiation and antiretroviral regimen).

Results: Mortality rates in the districts ranged from the lowest 1.0 (95% CI 0.9-1.1) in Selibe-Phikwe, to the highest 5.0 (95% CI 4.0-6.1), in Mabutsane. There was a wide range of overall LTFU across districts, including rates as low as 4.6 (95% CI 4.4-4.9) losses per 100 person-years in Ngamiland, and 5.9 (95% CI 5.6-6.2) losses per 100 person-years in South East district, to rates as high as 25.4 (95% CI 23.08-27.89) losses per 100 person-years in Mabutsane and 46.3 (95% CI 43.48-49.23) losses per 100 person-years in Okavango. Even when known risk factors for mortality and LTFU were adjusted for, district was a significant predictor of both mortality and LTFU rates.

Conclusion: We found statistically significant variation in attrition (mortality and LTFU) and data quality among districts. These findings suggest that district-level contextual factors affect retention in treatment. Further research needs to investigate factors that can potentially cause this variation.

Keywords: ART; HIV; TAR; VIH; Botswana; abandono; antiretroviral therapy; attrition; marginal structural model; modelo estructural marginal; modèle structurel marginal; multilevel; multinivel; à plusieurs niveaux.

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Figures

Figure 1
Figure 1
Distribution of HIV-Infected People on ART in Botswana(2013)
See this image and copyright information in PMC

References

    1. Atun R, Bataringaya J. Building a durable response to HIV/AIDS: implications for health systems. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2011;57:S91–S95. - PubMed
    1. WHO. Global update on HIV treatment 2013: results, impact and opportunities. Geneva: World Health Organization; 2013.
    1. M & E Unit. Monitoring & Evaluation Unit Monthly Report Feb. 2015. Gaborone, Botswana: Ministry of Health; 2015.
    1. Farahani M, Vable A, Lebelonyane R, Seipone K, Anderson M, Avalos A, et al. Outcomes of the Botswana national HIV/AIDS treatment programme from 2002 to 2010: a longitudinal analysis. The lancet global health. 2014;2:e44–e50. - PubMed
    1. Govindasamy D, Kranzer K, Ford N. Strengthening the HIV cascade to ensure an effective future ART response in sub-Saharan Africa. Transactions of The Royal Society of Tropical Medicine and Hygiene. 2014;108:1–3. - PubMed