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

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...

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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
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creator Jo, Youngji
Jamieson, Lise
Phiri, Bevis
Grimsrud, Anna
Mwansa, Muya
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Haimbe, Prudence
Mukumbwa-Mwenechanya, Mpande
Mulenga, Priscilla Lumano
Nichols, Brooke E
Rosen, Sydney
description 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
doi_str_mv 10.1371/journal.pone.0280748
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Academic</collection><collection>ProQuest Engineering Collection</collection><collection>Biological Sciences</collection><collection>Agriculture Science Database</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>ProQuest Engineering Database</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>ProQuest Advanced Technologies &amp; Aerospace Database</collection><collection>ProQuest Advanced Technologies &amp; Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jo, Youngji</au><au>Jamieson, Lise</au><au>Phiri, Bevis</au><au>Grimsrud, Anna</au><au>Mwansa, Muya</au><au>Shakwelele, Hilda</au><au>Haimbe, Prudence</au><au>Mukumbwa-Mwenechanya, Mpande</au><au>Mulenga, Priscilla Lumano</au><au>Nichols, Brooke E</au><au>Rosen, Sydney</au><au>Bartlett, Adam W.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Attrition from HIV treatment after enrollment in a differentiated service delivery model: A cohort analysis of routine care in Zambia</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2023-03-14</date><risdate>2023</risdate><volume>18</volume><issue>3</issue><spage>e0280748</spage><epage>e0280748</epage><pages>e0280748-e0280748</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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 &lt;2% enrolled in the other DSD groups. Retention was higher in nearly all DSD models for all dispensing intervals, compared to the reference group, except fast track for the ≤2 month dispensing group. Retention benefits were greatest for patients in the extended clinic hours group and least for fast track dispensing. Although retention in HIV treatment differed by DSD type, dispensing interval, and patient characteristics, nearly all DSD models out-performed conventional care. Understanding the factors that influence the retention of patients in DSD models could provide an important step towards improving DSD implementation.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>36917568</pmid><doi>10.1371/journal.pone.0280748</doi><tpages>e0280748</tpages><orcidid>https://orcid.org/0000-0002-6560-2964</orcidid><orcidid>https://orcid.org/0000-0002-1199-8377</orcidid><oa>free_for_read</oa></addata></record>
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identifier ISSN: 1932-6203
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issn 1932-6203
1932-6203
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source Publicly Available Content Database; PubMed; Coronavirus Research Database
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
title Attrition from HIV treatment after enrollment in a differentiated service delivery model: A cohort analysis of routine care in Zambia
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