Effect of Community ART Groups on retention-in-care among patients on ART in Tete Province, Mozambique: a cohort study

ObjectivesEstimate the effect of participation in Community ART Groups (CAG) versus individual care on retention-in-care (RIC) on antiretroviral therapy (ART).DesignRetrospective cohort study.SettingHigh levels of attrition (death or loss-to-follow-up (LTFU) combined) on ART indicate that delivery m...

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Bibliographic Details
Published in:BMJ open 2017-08, Vol.7 (8), p.e016800-e016800
Main Authors: Decroo, Tom, Telfer, Barbara, Dores, Carla Das, White, Richard A, Santos, Natacha Dos, Mkwamba, Alec, Dezembro, Sergio, Joffrisse, Mariano, Ellman, Tom, Metcalf, Carol
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Adult
AIDS
Anti-HIV Agents - therapeutic use
Antiretroviral drugs
Clinics
Cohort analysis
Community Health Services
Community Participation
Community support
Decentralization
Delivery of Health Care - methods
Drug therapy
Female
Group Processes
Health Facilities
Health Services Accessibility
HIV
HIV Infections - drug therapy
HIV/AIDS
Human immunodeficiency virus
Humans
Lost to Follow-Up
Male
Mozambique
Nurses
Patient Dropouts
Patients
Proportional Hazards Models
Qualitative Research
Retention
Retrospective Studies
Rural areas
Support groups
Survival Analysis
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Summary:ObjectivesEstimate the effect of participation in Community ART Groups (CAG) versus individual care on retention-in-care (RIC) on antiretroviral therapy (ART).DesignRetrospective cohort study.SettingHigh levels of attrition (death or loss-to-follow-up (LTFU) combined) on ART indicate that delivery models need to adapt in sub-Saharan Africa. In 2008, patients more than 6 months on ART began forming CAG, and took turns to collect ART refills at the health facility, in Tete Province, Mozambique,.Participants2406 adult patients, retained in care for at least 6 months after starting ART, during the study period (date of CAG introduction at the health facility—30 April 2012).MethodsData up to 30 April 2012 were collected from patient records at eight health facilities. Survival analysis was used to compare RIC among patients in CAG and patients in individual care, with joining a CAG treated as an irreversible time-dependent variable. Multivariable Cox regression was used to estimate the effect of CAG on RIC, adjusted for age, sex and health facility type and stratified by calendar cohort.Results12-month and 24-monthRIC from the time of eligibility were, respectively, 89.5% and 82.3% among patients in individual care and 99.1% and 97.5% among those in CAGs (p
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2017-016800