Retention and predictors of attrition among patients who started antiretroviral therapy in Zimbabwe's national antiretroviral therapy programme between 2012 and 2015

• Published in: PloS one 2020-01, Vol.15 (1), p.e0222309
• Main Authors: Makurumidze, Richard, Mutasa-Apollo, Tsitsi, Decroo, Tom, Choto, Regis C, Takarinda, Kudakwashe C, Dzangare, Janet, Lynen, Lutgarde, Van Damme, Wim, Hakim, James, Magure, Tapuwa, Mugurungi, Owen, Rusakaniko, Simbarashe
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adolescents; Adult; Adults; AIDS; Analysis; Anti-HIV Agents - adverse effects; Anti-HIV Agents - therapeutic use; Anti-Retroviral Agents - adverse effects; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Biology and Life Sciences; Child; Child care; Child, Preschool; Children; Children & youth; Clinical outcomes; Demographics; Disease control; Drug resistance; Drug therapy; Evaluation; Female; Gerontology; Health care; Health care facilities; Health facilities; Health sciences; Highly active antiretroviral therapy; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - virology; HIV patients; Human immunodeficiency virus; Humans; Infant; Infant, Newborn; Infections; Laboratories; Male; Medical diagnosis; Medical research; Medication Adherence - psychology; Medicine; Medicine and Health Sciences; Middle Aged; Patients; People and Places; Pharmacy; Pregnancy; Primary health care; Public health; Public sector; Regression analysis; Regression models; Retention; Retrospective Studies; Studies; Survival Analysis; Teenagers; Therapy; Tuberculosis; Young Adult; Young adults; Youth; Zimbabwe - epidemiology
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0222309

The last evaluation to assess outcomes for patients receiving antiretroviral therapy (ART) through the Zimbabwe public sector was conducted in 2011, covering the 2007-2010 cohorts. The reported retention at 6, 12, 24 and 36 months were 90.7%, 78.1%, 68.8% and 64.4%, respectively. We report findings of a follow-up evaluation for the 2012-2015 cohorts to assess the implementation and impact of recommendations from this prior evaluation. A nationwide retrospective study was conducted in 2016. Multi-stage proportional sampling was used to select health facilities and study participants records. The data extracted from patient manual records included demographic, baseline clinical characteristics and patient outcomes (active on treatment, died, transferred out, stopped ART and lost to follow-up (LTFU)) at 6, 12, 24 and 36 months. The data were analysed using Stata/IC 14.2. Retention was estimated using survival analysis. The predictors associated with attrition were determined using a multivariate Cox regression model. A total of 3,810 participants were recruited in the study. The median age in years was 35 (IQR: 28-42). Overall, retention increased to 92.4% (p-value = 0.060), 86.5% (p-value