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Patient retention and attrition on antiretroviral treatment at district level in rural Malawi.

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dc.contributor Médecins Sans Frontières, Thyolo District, Thyolo, Malawi.
dc.creator Massaquoi, M
dc.creator Zachariah, R
dc.creator Manzi, M
dc.creator Pasulani, O
dc.creator Misindi, D
dc.creator Mwagomba, B
dc.creator Bauernfeind, A
dc.creator Harries, A D
dc.date 2009-06
dc.date.accessioned 2017-01-31T07:14:18Z
dc.date.available 2017-01-31T07:14:18Z
dc.identifier Patient retention and attrition on antiretroviral treatment at district level in rural Malawi. 2009, 103 (6):594-600 Trans. R. Soc. Trop. Med. Hyg.
dc.identifier 0035-9203
dc.identifier 19298993
dc.identifier 10.1016/j.trstmh.2009.02.012
dc.identifier http://hdl.handle.net/10144/71876
dc.identifier http://fieldresearch.msf.org/msf/handle/10144/71876
dc.identifier Transactions of the Royal Society of Tropical Medicine and Hygiene
dc.identifier.uri http://dspace.mediu.edu.my:8181/xmlui/handle/10144/71876
dc.description We report on rates of patient retention and attrition in the context of scaling-up antiretroviral treatment (ART) within a district hospital and its primary health centres in rural Malawi. 'Retention' was defined as being alive and on ART or transferred out, whereas 'attrition' was defined as died, lost to follow-up or stopped treatment. A total of 4074 patients were followed-up for 1803 person-years: 2904 were at the hospital and 1170 at health centres. Approximately 85% of patients were retained in care, both at hospital and health centres, with a retention rate per 100 person-years of 185 and 211, respectively [adjusted hazard ratio (HR) 1.18, 95% CI 1.10-1.28, P=0.001). Attrition rates per 100 person-years were similar: 33 and 36, respectively (adjusted HR 1.17, 95% CI 0.97-1.4, P=0.1). At health centres the incidence of loss to follow-up was significantly lower than at the hospital (adjusted HR 0.24, P<0.001, risk reduction 77%), but the rate of reported deaths was higher at health centres (adjusted HR 2.2, 95% CI 1.76-2.72, P<0.001). As Malawi continues to extend the coverage (and equity) of ART, including in rural areas, attention is needed to reduce losses to follow-up at hospital level and reduce mortality at primary care level.
dc.language en
dc.publisher Published by Elsevier
dc.relation http://www.sciencedirect.com/science/journal/00359203
dc.rights Published by Elsevier Archived on this site with the kind permission of Elsevier Ltd. ([url]http://www.sciencedirect.com/science/journal/00359203[/url]) and the Royal Society of Tropical Medicine and Hygiene ([url]http://www.rstmh.org/transactions.asp[/url])
dc.title Patient retention and attrition on antiretroviral treatment at district level in rural Malawi.


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