Attrition from HIV treatment after enrollment in a differentiated service delivery model: A cohort analysis of routine care in Zambia

• Published in: PloS one 2023-03, Vol.18 (3), p.e0280748-e0280748
• Main Authors: Jo, Youngji, Jamieson, Lise, Phiri, Bevis, Grimsrud, Anna, Mwansa, Muya, Shakwelele, Hilda, Haimbe, Prudence, Mukumbwa-Mwenechanya, Mpande, Mulenga, Priscilla Lumano, Nichols, Brooke E, Rosen, Sydney
• Format: Article
• Language: English
• Subjects: Adult; AIDS treatment; Analysis; Anti-HIV Agents - therapeutic use; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antiviral agents; Biology and Life Sciences; Care and treatment; Clinical outcomes; Cohort analysis; Cohort Studies; Computer and Information Sciences; Datasets; Dispensing; Dosage and administration; Drug therapy; Electronic health records; Electronic medical records; Enrollments; Health risks; HIV; HIV (Viruses); HIV Infections - drug therapy; HIV Infections - epidemiology; HIV patients; Human immunodeficiency virus; Humans; Medical records; Medical research; Medicine and Health Sciences; Medicine, Experimental; Modelling; Patient satisfaction; Patients; People and Places; Retention; Retrospective Studies; Sexually transmitted diseases; STD; Urban areas; Urban environments; Zambia - epidemiology
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0280748

Many sub-Saharan Africa countries are scaling up differentiated service delivery (DSD) models for HIV treatment to increase access and remove barriers to care. We assessed factors associated with attrition after DSD model enrollment in Zambia, focusing on patient-level characteristics. We conducted a retrospective record review using electronic medical records (EMR) of adults (≥15 years) initiated on antiretroviral (ART) between 01 January 2018 and 30 November 2021. Attrition was defined as lost to follow-up (LTFU) or died by November 30, 2021. We categorized DSD models into eight groups: fast-track, adherence groups, community pick-up points, home ART delivery, extended facility hours, facility multi-month dispensing (MMD, 4-6-month ART dispensing), frequent refill care (facility 1-2 month dispensing), and conventional care (facility 3 month dispensing, reference group). We used Fine and Gray competing risk regression to assess patient-level factors associated with attrition, stratified by sex and rural/urban setting. Of 547,281 eligible patients, 68% (n = 372,409) enrolled in DSD models, most commonly facility MMD (n = 306,430, 82%), frequent refill care (n = 47,142, 13%), and fast track (n = 14,433, 4%), with