setting and origin of data
DESCRIPTION
Changes in baseline characteristics and retention during scaling-up of ART: cohort-assessment 2005 to 2010, rural Lesotho. Niklaus D. Labhardt, Motlalepula Sello , Jan S. Emmel , Masetsibi Motlomelo , Thomas Gass , Karolin Pfeiffer, M.A. Mohlaba , Jochen Ehmer. - PowerPoint PPT PresentationTRANSCRIPT
Niklaus D. Labhardt, Motlalepula Sello, Jan S. Emmel, Masetsibi Motlomelo, Thomas Gass, Karolin Pfeiffer, M.A. Mohlaba, Jochen Ehmer
Changes in baseline characteristics and retention during scaling-up of ART: cohort-assessment 2005 to 2010, rural Lesotho
Setting and Origin of Data
• Adult HIV-prevalence*: 23.6%
• ART at hospitals: since 2005
• ART at health-centers: 2007/08
• SMART: SolidarMed anti-retroviral treatment project
*Demographic Health Survey of Lesotho 2009
Seboche1 hospital, 5 health centersPopulation: ~ 55‘000Adult prevalence*: ~ 16%
Paray1 hospital, 7 health centersPopulation: ~ 77‘000Adult prevalence*: ~ 20%
Data-processing
Objectives: To describe from 2005 to 2010
• change in scaling-up• change in baseline-characteristics• Short-term retention in care
Number of patients initiated on ART per year
Continuation of trend first-half 2011
Estimated adult ART-coverage: 50%
CD4-count at initiation of ART
Clinical WHO-stage at initiation of ART
No follow-up after ART-initiation
ART-initiation No follow-up 95% CI
2006 10.2% 7.5, 13.4
2007 9.8% 7.5, 12.5
2008 4.9% 3.7, 6.4
2009 5.8% 4.7, 7.1
2010 5.8% 4.6, 7.2
ART-initiation No follow-up 95% CI
2005 10.7% 4.7, 19.9
2006 10.2% 7.5, 13.4
2007 9.8% 7.5, 12.5
2008 4.9% 3.7, 6.4
2009 5.8% 4.7, 7.1
2010 5.8% 4.6, 7.2
No follow-up after ART-initiation
ART-initiation No follow-up 95% CI
2005 10.7% 4.7, 19.9
2006 10.2% 7.5, 13.4
2007 9.8% 7.5, 12.5
2008 4.9% 3.7, 6.4
2009 5.8% 4.7, 7.1
2010 5.8% 4.6, 7.2
OR: 1.50 (1.18, 1.91)
No follow-up after ART-initiation
OR: 1.50 (1.18, 1.91)
Predictor Adj OR 95% CI p-value
CD4-baseline <100 1.64 1.27, 2.12 <0.001
WHO-stage 3 or 4 1.55 1.21, 1.99 0.001
Female Sex 0.79 0.62, 1.01 0.061
Year <2008 1.07 0.79, 1.43 0.654
ART-initiation No follow-up 95% CI
2005 10.7% 4.7, 19.9
2006 10.2% 7.5, 13.4
2007 9.8% 7.5, 12.5
2008 4.9% 3.7, 6.4
2009 5.8% 4.7, 7.1
2010 5.8% 4.6, 7.2
One-year retention on ARTART-initiation Followup ≥ 1 year 95%CI
2006 73.5% 69.2, 77.6
2007 74.7% 70.9, 78.2
2008 79.1% 76.4, 81.1
2009 74.2% 71.6, 76.7
One-year retention on ARTART-initiation Followup ≥ 1 year 95%CI
2006 73.5% 69.2, 77.6
2007 74.7% 70.9, 78.2
2008 79.1% 76.4, 81.1
2009 74.2% 71.6, 76.7
OR: 0.89 (0.75, 1.06)
One-year retention on ARTART-initiation Followup ≥ 1 year 95%CI
2006 73.5% 69.2, 77.6
2007 74.7% 70.9, 78.2
2008 79.1% 76.4, 81.1
2009 74.2% 71.6, 76.7
OR: 0.89 (0.75, 1.06)
Predictor Variables Adjusted OR 95% CI P-value
CD4-baseline <100 0.61 0.51, 0.73 <0.001
WHO-stage 3 or 4 0.71 0.60, 0.84 <0.001
Female Sex 1.25 1.06, 1.48 0.009
Year <2008 1.15 0.95, 1.39 0.145
Summary• Scaling-up slows down despite
decentralization to health-centers– Further decentralization?
• Patients initiated at an earlier clinical stage– reduction of proportion without
any follow-up after initiation (early mortality)
• No improvement in one-year retention– Benefit of early initiation does not
translate into better retention
Acknowledgements