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Home >> Publications >> Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared.

Publication

Author(s):

Labhardt ND, Keiser O, Sello M, Lejone TI, Pfeiffer K, Davies MA, Egger M, Ehmer J, Wandeler G; SolidarMed ART Program and IeDEA-Southern Africa.

Pub Title:

Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared.

Pub Date:

Nov 21 2013

Pub Region(s):

Southern Africa

Journal Issue:

16:18616

Journal:

Title: 
JIAS- Journal of the International AIDS Society
Link: 
http://www.jiasociety.org/index.php/jias/article/view/18616

PubMed: 24267671
Pub PDF: PDF icon 24267671.pdf

Abstract
Introduction: Lesotho was among the first countries to adopt decentralization of care from hospitals to nurse-led health centres (HCs) to scale up the provision of antiretroviral therapy (ART). We compared outcomes between patients who started ART at HCs and hospitals in two rural catchment areas in Lesotho. Methods: The two catchment areas comprise two hospitals and 12 HCs. Patients ≥16 years starting ART at a hospital or HC between 2008 and 2011 were included. Loss to follow-up (LTFU) was defined as not returning to the facility for ≥180 days after the last visit, no follow-up (no FUP) as not returning after starting ART, and retention in care as alive and on ART at the facility. The data were analysed using logistic regression, competing risk regression and Kaplan-Meier methods. Multivariable analyses were adjusted for sex, age, CD4 cell count, World Health Organization stage, catchment area and type of ART. All analyses were stratified by gender. Results: Of 3747 patients, 2042 (54.5%) started ART at HCs. Both women and men at hospitals had more advanced clinical and immunological stages of disease than those at HCs. Over 5445 patient-years, 420 died and 475 were LTFU. Kaplan-Meier estimates for three-year retention were 68.7 and 69.7% at HCs and hospitals, respectively, among women (p=0.81) and 68.8% at HCs versus 54.7% at hospitals among men (p<0.001). These findings persisted in adjusted analyses, with similar retention at HCs and hospitals among women (odds ratio (OR): 0.89, 95% confidence interval (CI): 0.73-1.09) and higher retention at HCs among men (OR: 1.53, 95% CI: 1.20-1.96). The latter result was mainly driven by a lower proportion of patients LTFU at HCs (OR: 0.68, 95% CI: 0.51-0.93). Conclusions: In rural Lesotho, overall retention in care did not differ significantly between nurse-led HCs and hospitals. However, men seemed to benefit most from starting ART at HCs, as they were more likely to remain in care in these facilities compared to hospitals.

KEYWORDS: HIV, antiretroviral treatment, decentralization, nurse-based care, retention in care, rural Southern Africa, task shifting

PMID: 24267671 [PubMed - in process] PMCID: PMC3838571

 

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Citation:

Labhardt ND, Keiser O, Sello M, Lejone TI, Pfeiffer K, Davies MA, Egger M, Ehmer J, Wandeler G; SolidarMed ART Program and IeDEA-Southern Africa. Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared. J Int AIDS Soc. 2013 Nov 21;16:18616. doi: 10.7448/IAS.16.1.18616. PubMed PMID: 24267671; PubMed Central PMCID: PMC3838571.