Changes in patterns of retention in HIV care and antiretroviral treatment in Tanzania between 2008 and 2016

An analysis of routinely collected national programme data

Dados Bibliográficos

ID19552494
AutoresPaul Mee (0000-0003-0912-0984, London School of Hygiene & Tropical Medicine, autor correspondente), Brian Rice (0000-0002-5416-8058, London School of Hygiene & Tropical Medicine), Liis Lemsalu (0000-0002-4818-0683, London School of Hygiene & Tropical Medicine), Julian Hargreaves (0000-0002-3509-3572, London School of Hygiene & Tropical Medicine), James Hargreaves, Veryeh Sambu, Richelle Harklerode (0000-0001-7166-2325, Global Brain Health Institute), Jim Todd (0000-0001-5918-4914, London School of Hygiene & Tropical Medicine), Geoffrey Somi
Ano2019
Volume9
Fascículo1
Páginas010424-010424
Data de publicação2019-06-01
Peer ReviewedSim
Open AccessSim
TipoARTICLE
PeriódicoJournal of Global Health (JOURNAL)
Identificadores do periódicoISSN: 2047-2978 • E-ISSN: 2047-2986
EditoraInternational Society of Global Health (PUBLISHER • GB)
DOI10.7189/jogh.09.010424
PMID30992984
OpenAlexW2929737400
IdiomaEN
Citações recebidas7
Referências citadas18

BACKGROUND: Tanzania is a high HIV burden country in Sub-Saharan Africa with 1.5 million people infected. Unless monitored and responded to, low levels of retention in care may lead to poor HIV associated clinical outcomes and an increased likelihood of onward viral transmission. Using routine data, we assessed changes in retention in care and on treatment for HIV over time in Tanzanian facilities, using the national care and treatment programme (CTC) database. METHODS: Data were extracted from the CTC database and analysed using two approaches: a series of cross-sectional analyses for each calendar year between 2008 and 2016 to assess the changing characteristics of the population in care and on treatment, and, a longitudinal analysis using survival analysis methods for a series of cohorts representing i) all engaging in care and ii) all initiating treatment in each calendar year from 2008 to 2015. Multivariate analyses were carried out to explore the independent effect of calendar year when controlling for other factors. RESULTS: The total number of individuals enrolled in care increased from 160 268 in 2008 to 548 296 in 2016. The percentage of the in-care population enrolled for more than 3 years increased from 9.9% in 2008 to 54.5% in 2016. The overall rates of retention in care were 80.9%, 57.3% and 45.4% at 12, 24 and 36 months respectively. The rates of retention on antiretroviral therapy (ART) ART at 12, 24 and 36 months after treatment-initiation were 83.9%, 64.0% and 53.5%. There were small but statistically significant differences in the retention rates between cohorts and evidence for a significant decrease in the rates of retention in the most recent years analysed. CONCLUSIONS: Data from Tanzania show that while the number of People Living with HIV (PLHIV) who were in care and monitored through the routine data system increased over time, the retention rates in care and treatment remained relatively stable. These rates were similar to other regional estimates. Systematic reviews of tracing studies indicate that mortality among those lost to follow up has decreased over time, partly underpinned by an increase in the numbers transferring between clinics. True retention rates may therefore be higher than we report here, and this underpins the need for data systems that can track patients between clinics

Antiretroviral therapy · Environmental health · Family medicine · Geography · Multivariate analysis · Population · Retention rate · Tanzania · Viral load · Adolescent Sexual and Reproductive Health · Demography · Global Maternal and Child Health · HIV/AIDS Research and Interventions · Medicine · Internal Medicine · Pediatrics