Patient Volume, Human Resource Levels, and Attrition From HIV Treatment Programs in Central Mozambique

Abstract

Introduction Human resource shortages are viewed as one of the primary obstacles to provide effective services to growing patient populations receiving antiretroviral therapy (ART) and to expand ART access further. We examined the relationship of patient volume, human resource levels and patient characteristics with attrition from HIV treatment programs in central Mozambique. Methods We conducted a retrospective cohort study of adult, ART-naïve, non-pregnant patients who initiated ART between January 2006 and June 2008 in the national HIV care program. Cox proportional hazards models were used to assess the association of patient volume, clinical staff burden, and pharmacy staff burden with attrition, while adjusting for patient characteristics. Results A total of 11,793 patients from 18 clinics were studied. After adjusting for patient characteristics, patients attending clinics with medium pharmacy staff burden (HR= 1.39 [95% CI: 1.07–1.80]) and high pharmacy staff burden (HR = 2.09 [95% CI: 1.50–2.91]) tended to have a higher risk of attrition (p-value for trend: <0.001). Patients attending clinics with higher clinical staff burden did not have a statistically higher risk of attrition. Patients attending clinics with medium patient volume levels (HR= 1.45 [95% CI: 1.04–2.04]) and high patient volume levels (HR = 1.41 [95% CI: 1.04–2.92]) had a higher risk of attrition, but the trend test was not significant (p=0.198). Discussion Patients attending clinics with higher pharmacy staff burden had a higher risk of attrition. These results highlight a potential area within the health system where interventions could be applied to improve the retention of these patient populations.

Integration of HIV Care and Treatment in Primary Health Care Centers and Patient Retention in Central Mozambique

“…We also adjusted for a key confounder, pharmacy staff burden, an important predictor of attrition in previous research. 20 Furthermore, our findings were robust to sensitivity analyses.…”

“…3,19,20,26–28 Integration of HIV care and treatment services into the existing primary health care system dramatically improved access to care and potentially reduced the time from enrolling into care to ART initiation among those initiating treatment. Even though parallel systems were built, vertical clinics were originally tailored to address the specific needs of HIV care and treatment delivery that could explain, in part, why there was a lower risk of attrition among patients attending these clinics.…”

“…Clinic characteristics considered as potential confounders included pharmacy staff burden (number of pharmacy visits/number of pharmacy staff), treated as a time-varying covariate, because it has been shown to be an important predictor of patient attrition in other research. 20 Consideration of which covariables to include was based on their theoretical plausibility to confound the relationship between our clinic-level exposures of interest and patient attrition.…”

“…We allowed variables to have time-varying effects between early and late patient follow-up based on results from previous analyses. 20 …”

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“…These results highlighted the poor service delivery which confirmed similar reports by Lambdin et al (2011) [47].…”