Patient attrition from the HIV antiretroviral therapy program at two hospitals in Haiti
OBJECTIVE: To identify factors associated with antiretroviral therapy (ART) attrition among patients initiating therapy in 2005-2011 at two large, public-sector department-level hospitals, and to inform interventions to improve ART retention. METHODS: This retrospective cohort study used data from t...
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ftdoajarticles:oai:doaj.org/article:4d7f403475754c5bb3be394e39bda6b8 2023-05-15T15:12:36+02:00 Patient attrition from the HIV antiretroviral therapy program at two hospitals in Haiti Nancy H. Puttkammer Steven B. Zeliadt Janet G. Baseman Rodney Destiné Jean Wysler Domerçant Nancy Rachel Labbé Coq Nernst Atwood Raphael Kenneth Sherr Mary Tegger Krista Yuhas Scott Barnhart 2014-10-01T00:00:00Z https://doaj.org/article/4d7f403475754c5bb3be394e39bda6b8 EN ES PT eng spa por Pan American Health Organization http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892014000900005&lng=en&tlng=en https://doaj.org/toc/1020-4989 1020-4989 https://doaj.org/article/4d7f403475754c5bb3be394e39bda6b8 Revista Panamericana de Salud Pública, Vol 36, Iss 4, Pp 238-247 (2014) VIH terapia antirretroviral altamente activa pérdida de seguimiento descentralización Haití Medicine R Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2014 ftdoajarticles 2022-12-30T23:48:18Z OBJECTIVE: To identify factors associated with antiretroviral therapy (ART) attrition among patients initiating therapy in 2005-2011 at two large, public-sector department-level hospitals, and to inform interventions to improve ART retention. METHODS: This retrospective cohort study used data from the iSanté electronic medical record (EMR) system. The study characterized ART attrition levels and explored the patient demographic, clinical, temporal, and service utilization factors associated with ART attrition, using time-to-event analysis methods. RESULTS: Among the 2 023 patients in the study, ART attrition on average was 17.0 per 100 person-years (95% confidence interval (CI): 15.8-18.3). In adjusted analyses, risk of ART attrition was up to 89% higher for patients living in distant communes compared to patients living in the same commune as the hospital (hazard ratio: 1.89, 95%CI: 1.54-2.33; P < 0.001). Hospital site, earlier year of ART start, spending less time enrolled in HIV care prior to ART initiation, receiving a non-standard ART regimen, lacking counseling prior to ART initiation, and having a higher body mass index were also associated with attrition risk. CONCLUSIONS: The findings suggest quality improvement interventions at the two hospitals, including: enhanced retention support and transportation subsidies for patients accessing care from remote areas; counseling for all patients prior to ART initiation; timely outreach to patients who miss ART pick-ups; "bridging services" for patients transferring care to alternative facilities; routine screening for anticipated interruptions in future ART pick-ups; and medical case review for patients placed on non-standard ART regimens. The findings are also relevant for policymaking on decentralization of ART services in Haiti. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic |
institution |
Open Polar |
collection |
Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English Spanish Portuguese |
topic |
VIH terapia antirretroviral altamente activa pérdida de seguimiento descentralización Haití Medicine R Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
spellingShingle |
VIH terapia antirretroviral altamente activa pérdida de seguimiento descentralización Haití Medicine R Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Nancy H. Puttkammer Steven B. Zeliadt Janet G. Baseman Rodney Destiné Jean Wysler Domerçant Nancy Rachel Labbé Coq Nernst Atwood Raphael Kenneth Sherr Mary Tegger Krista Yuhas Scott Barnhart Patient attrition from the HIV antiretroviral therapy program at two hospitals in Haiti |
topic_facet |
VIH terapia antirretroviral altamente activa pérdida de seguimiento descentralización Haití Medicine R Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
OBJECTIVE: To identify factors associated with antiretroviral therapy (ART) attrition among patients initiating therapy in 2005-2011 at two large, public-sector department-level hospitals, and to inform interventions to improve ART retention. METHODS: This retrospective cohort study used data from the iSanté electronic medical record (EMR) system. The study characterized ART attrition levels and explored the patient demographic, clinical, temporal, and service utilization factors associated with ART attrition, using time-to-event analysis methods. RESULTS: Among the 2 023 patients in the study, ART attrition on average was 17.0 per 100 person-years (95% confidence interval (CI): 15.8-18.3). In adjusted analyses, risk of ART attrition was up to 89% higher for patients living in distant communes compared to patients living in the same commune as the hospital (hazard ratio: 1.89, 95%CI: 1.54-2.33; P < 0.001). Hospital site, earlier year of ART start, spending less time enrolled in HIV care prior to ART initiation, receiving a non-standard ART regimen, lacking counseling prior to ART initiation, and having a higher body mass index were also associated with attrition risk. CONCLUSIONS: The findings suggest quality improvement interventions at the two hospitals, including: enhanced retention support and transportation subsidies for patients accessing care from remote areas; counseling for all patients prior to ART initiation; timely outreach to patients who miss ART pick-ups; "bridging services" for patients transferring care to alternative facilities; routine screening for anticipated interruptions in future ART pick-ups; and medical case review for patients placed on non-standard ART regimens. The findings are also relevant for policymaking on decentralization of ART services in Haiti. |
format |
Article in Journal/Newspaper |
author |
Nancy H. Puttkammer Steven B. Zeliadt Janet G. Baseman Rodney Destiné Jean Wysler Domerçant Nancy Rachel Labbé Coq Nernst Atwood Raphael Kenneth Sherr Mary Tegger Krista Yuhas Scott Barnhart |
author_facet |
Nancy H. Puttkammer Steven B. Zeliadt Janet G. Baseman Rodney Destiné Jean Wysler Domerçant Nancy Rachel Labbé Coq Nernst Atwood Raphael Kenneth Sherr Mary Tegger Krista Yuhas Scott Barnhart |
author_sort |
Nancy H. Puttkammer |
title |
Patient attrition from the HIV antiretroviral therapy program at two hospitals in Haiti |
title_short |
Patient attrition from the HIV antiretroviral therapy program at two hospitals in Haiti |
title_full |
Patient attrition from the HIV antiretroviral therapy program at two hospitals in Haiti |
title_fullStr |
Patient attrition from the HIV antiretroviral therapy program at two hospitals in Haiti |
title_full_unstemmed |
Patient attrition from the HIV antiretroviral therapy program at two hospitals in Haiti |
title_sort |
patient attrition from the hiv antiretroviral therapy program at two hospitals in haiti |
publisher |
Pan American Health Organization |
publishDate |
2014 |
url |
https://doaj.org/article/4d7f403475754c5bb3be394e39bda6b8 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
Revista Panamericana de Salud Pública, Vol 36, Iss 4, Pp 238-247 (2014) |
op_relation |
http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892014000900005&lng=en&tlng=en https://doaj.org/toc/1020-4989 1020-4989 https://doaj.org/article/4d7f403475754c5bb3be394e39bda6b8 |
_version_ |
1766343260697001984 |