6 research outputs found
Distance to care, enrollment and loss to follow-up of HIV patients during decentralization of antiretroviral therapy in Neno District, Malawi: A retrospective cohort study
<div><p>HIV/AIDS remains the second most common cause of death in low and middle-income countries (LMICs), and only 34% of eligible patients in Africa received antiretroviral therapy (ART) in 2013. This study investigated the impact of ART decentralization on patient enrollment and retention in rural Malawi. We reviewed electronic medical records of patients registered in the Neno District ART program from August 1, 2006, when ART first became available, through December 31, 2013. We used GPS data to calculate patient-level distance to care, and examined number of annual ART visits and one-year lost to follow-up (LTFU) in HIV care. The number of ART patients in Neno increased from 48 to 3,949 over the decentralization period. Mean travel distance decreased from 7.3 km when ART was only available at the district hospital to 4.7 km when ART was decentralized to 12 primary health facilities. For patients who transferred from centralized care to nearer health facilities, mean travel distance decreased from 9.5 km to 4.7 km. Following a transfer, the proportion of patients achieving the clinic’s recommended ≥4 annual visits increased from 89% to 99%. In Cox proportional hazards regression, patients living ≥8 km from a health facility had a greater hazard of being LTFU compared to patients <8 km from a facility (adjusted HR: 1.7; 95% CI: 1.5–1.9). ART decentralization in Neno District was associated with increased ART enrollment, decreased travel distance, and increased retention in care. Increasing access to ART by reducing travel distance is one strategy to achieve the ART coverage and viral suppression objectives of the 90-90-90 UNAIDS targets in rural impoverished areas.</p></div
Association between travel distance to care and hazard of loss to follow up (LTFU), and exploratory analysis of association between patient covariates and LTFU.
<p>Association between travel distance to care and hazard of loss to follow up (LTFU), and exploratory analysis of association between patient covariates and LTFU.</p
ART decentralization timeline.
<p>The timeline displays HIV care in Neno District from August 1, 2006, when public care first became available, through December 31, 2012. (DH = district hospital, CH = community hospital, HC = health center, RHC = rural health center).</p
Demographic, clinical, and distance-to-care for patient cohorts during each phase of full decentralization.
<p>Demographic, clinical, and distance-to-care for patient cohorts during each phase of full decentralization.</p
Map of decentralization of ART services from 2008 to 2012.
<p>Crosses show location of health facilities. Dots show number of ART patients by home village, color-coded by health facility patient attended. Larger dots indicate a larger number of patients.</p
Comparison of demographic, clinical and distance data for transfers and non-transfers.
<p>Comparison of demographic, clinical and distance data for transfers and non-transfers.</p