Determinants and Consequences of Failure of Linkage to Antiretroviral Therapy at Primary Care Level in Blantyre, Malawi: A Prospective Cohort Study

MacPherson, Peter; Corbett, Elizabeth L.; Makombe, Simon D; Oosterhout, Joep J. van; Manda, Eddie; Choko, Augustine; Thindwa, Deus; Squire, S. Bertel; Mann, Gillian; Lalloo, David G.

doi:10.1371/journal.pone.0044794

Cited by 36 publications

(42 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients with underlying multidrug-resistant (MDR) TB treated with first-line therapy were assumed to have worse outcomes. We assumed that 15% of patients testing positive would not complete a sufficient course of therapy to achieve cure 9 . Patients who were false negatives or lost to follow-up had the opportunity of a future TB diagnosis with sputum smear microscopy through the routine health system 8, 10, 11 .…”

Section: Methodsmentioning

confidence: 99%

Screening for Tuberculosis Among Adults Newly Diagnosed With HIV in Sub-Saharan Africa

Zwerling

Sahu

Ngwira

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

Self Cite

View full text Add to dashboard Cite

Objective New tools, including light emitting diode (LED) fluorescence microscopy and the molecular assay Xpert MTB/RIF® offer increased sensitivity for TB in persons with HIV but come with higher costs. Using operational data from rural Malawi we explored the potential cost-effectiveness of on-demand screening for TB in low-income countries of sub-Saharan Africa. Design & Methods Costs were empirically collected in four clinics and one hospital using a micro-costing approach, through direct interview and observation from the national TB program perspective. Using decision analysis newly diagnosed persons with HIV were modeled as being screened by one of three strategies: Xpert, LED or standard of care (i.e., at the discretion of the treating physician). Results Cost-effectiveness of TB screening among persons newly diagnosed with HIV was largely determined by two factors: prevalence of active TB among patients newly diagnosed with HIV and volume of testing. In facilities screening at least 50 people with a 6.5% prevalence of TB, or at least 500 people with a 2.5% TB prevalence, screening with Xpert is likely to be cost-effective. At lower prevalence – including that observed in Malawi – LED microscopy may be the preferred strategy, whereas in settings of lower TB prevalence or small numbers of eligible patients, no screening may be reasonable (such that resources can be deployed elsewhere). Conclusions TB screening at the point of HIV diagnosis may be cost-effective in low-income countries of sub-Saharan Africa, but only if a relatively large population with high prevalence of TB can be identified for screening.

show abstract

Section: Methodsmentioning

confidence: 99%

Screening for Tuberculosis Among Adults Newly Diagnosed With HIV in Sub-Saharan Africa

Zwerling

Sahu

Ngwira

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

Self Cite

View full text Add to dashboard Cite

show abstract

“…Baseline characteristics of cohort study participants, patterns of HTC and linkage to ART have previously been described [14,15]. …”

Section: Methodsmentioning

confidence: 99%

Barriers and facilitators to linkage to ART in primary care: a qualitative study of patients and providers in Blantyre, Malawi

MacPherson

Mwale

et al. 2012

Journal of the International AIDS Society

Self Cite

View full text Add to dashboard Cite

IntroductionLinkage from HIV testing and counselling (HTC) to initiation of antiretroviral therapy (ART) is suboptimal in many national programmes in sub-Saharan Africa, leading to delayed initiation of ART and increased risk of death. Reasons for failure of linkage are poorly understood.MethodsSemi-structured qualitative interviews were undertaken with health providers and HIV-positive primary care patients as part of a prospective cohort study at primary health centres in Blantyre, Malawi. Patients successful and unsuccessful in linking to ART were included.ResultsProgression through the HIV care pathway was strongly influenced by socio-cultural norms, particularly around the perceived need to regain respect lost during a period of visibly declining health. Capacity to call upon the support of networks of families, friends and employers was a key determinant of successful progression. Over-busy clinics, non-functioning laboratories and unsuitable tools used for ART eligibility assessment (WHO clinical staging system and centralized CD4 count measurement) were important health systems determinants of drop-out.ConclusionsKey interventions that could rapidly improve linkage include guarantee of same-day, same-clinic ART eligibility assessments; utilization of the support offered by peer-groups and community health workers; and integration of HTC and ART programmes.

show abstract

“…Other studies have shown that many patients drop out of the programs even before ART initiation with a failure of linkage to ART after HIV testing [47]–[49].…”

Section: Discussionmentioning

confidence: 99%

Effective Coverage for Antiretroviral Therapy in a Ugandan District with a Decentralized Model of Care

Scheibe

Waiswa

Kadobera³

et al. 2013

PLoS ONE

View full text Add to dashboard Cite

IntroductionWhile increasing access to antiretroviral therapy (ART) is reported from many African countries, data on effective coverage particular from settings without external support or research remains scarce. We examined and report effective coverage data from a public ART program in rural Uganda.MethodsWe conducted a retrospective cohort study at all ART-providing governmental health facilities in Iganga District, Eastern Uganda. Based on all HIV patients registered between April 2004 and September 2009 (n = 4775), we assessed indicators of program performance and determined rates of retention and Cox proportional hazards for attrition. Effective ART coverage was calculated using projections (SPECTRUM software) adapted to the district demographic structure and number of people receiving ART.ResultsBy September 2009, district public sector effective ART coverage was 10.3% for adults and 1.9% for children. After a median follow-up of 26.9 months, overall ART retention was 54.7%. The probability of retention was 0.72 (95% confidence interval (CI) 0.69–0.75) at 12 and 0.58 (CI 0.54–0.62) at 36 months after ART initiation. Individual health facilities differed considerably regarding performance indicators and retention. Overall, 198 (16.9%) individual files of 1171 registered ART patients were lost. Young adult age (15–24 years) had a higher risk of attrition (HR 2.1, CI 1.4–3.2) as well as WHO stage I (HR 4.8, CI 1.9–11.8) and WHO stage IV (HR 2.5, CI 1.3–4.7). An interval ≥6 weeks between HIV testing and ART initiation was associated with a reduced risk (HR 0.6, CI 0.47–0.78).ConclusionCompared to reported national data effective ART coverage in Iganga District was low. Intensified efforts to improve access, retention in care, and quality of documentation are urgently needed. Children and young adults require special attention in the program.

show abstract

Determinants and Consequences of Failure of Linkage to Antiretroviral Therapy at Primary Care Level in Blantyre, Malawi: A Prospective Cohort Study

Cited by 36 publications

References 30 publications

Screening for Tuberculosis Among Adults Newly Diagnosed With HIV in Sub-Saharan Africa

Screening for Tuberculosis Among Adults Newly Diagnosed With HIV in Sub-Saharan Africa

Barriers and facilitators to linkage to ART in primary care: a qualitative study of patients and providers in Blantyre, Malawi

Effective Coverage for Antiretroviral Therapy in a Ugandan District with a Decentralized Model of Care

Contact Info

Product

Resources

About