202660 Impact of Patient Volume on Loss to Follow-up and Mortality in Antiretroviral Therapy Programs in Mozambique

Tuesday, November 10, 2009: 4:30 PM

Barrot Lambdin, MPH , Health Alliance International, Seattle, WA
Mark A. Micek, MD, MPH , Department of Global Health, University of Washington, Seattle, WA
James Pfeiffer, PhD, MPH , School of Public Health, Department of Health Services, Univertsity of Washington, Seattle, WA
Pablo Montoya, MD, MPH , Beira office, Health Alliance International, Chimoio, Mozambique
Kenneth Gimbel-Sherr, MPH, PhC , Health Alliance International, University of Washington, Seattle, WA
Juvenol Amos , DPS Sofala, Beira, Mozambique
Luis Francisco , DPS Manica, Chimoio, Mozambique
Nunes Sampaio , Health Alliance International, Beira, Mozambique
Alejandro Soto, MD, MPH , Health Alliance International, Seattle, WA
Stephen Gloyd, MD, MPH , Health Alliance International, University of Washington, Seattle, WA
The Mozambican Ministry of Health (MOH) in 2004 initiated a national scale-up of anti-retroviral therapy (ART) using primarily a vertical model of day hospitals within high population centers. In order to expand ART coverage, the MOH initiated ART-delivery within primary health care clinics in 2006. Despite efforts of scaling up services to meet the growing population of ART-recipients, concern remains that high patient volume at clinics is overburdening the health system. We therefore conducted a study to examine the relationship of patient volume with loss to follow-up and mortality among patients on ART.

Data were aggregated for 24 HIV treatment clinics in Manica and Sofala provinces. Linear regression models with robust standard errors were used to assess the relationship of patient volume with loss to follow-up and mortality. Survival analyses will be used to analyze patient-level, time-until-event data.

Of the 24 HIV treatment clinics, the median patient population size is 557 with a range from 100 to 5,468 patients per clinic. Patient volume is significantly associated with the percent loss to follow-up (p=0.001) with higher patient volumes tending to have more loss to follow-up. The estimated percent loss to follow-up is 7.56% in a HIV treatment clinic with 500 patients and is 20.95% in a clinic with 5,000 patients. Patient volume is not significantly associated with mortality.

As ART-delivery continues to be scaled-up, strategies to relieve the patient burden on clinics need to be considered. Addressing these barriers will lead to better retention and more efficient delivery of HIV treatment.

Learning Objectives:
1. Describe the association between patient volume and patient attrition in antiretroviral therapy programs in Manica and Sofala provinces of Mozambique.

Keywords: Antiretroviral Combination Therapy, Adherence

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have an MPH for the Department of Global Health at Emory University; have been active in HIV research for the past 5 years; have authored HIV-specific research articles; have managed HIV projects in Zambia; and am currently a doctoral student in the Department of Epidemiology at the University of Washington.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: HIV/AIDS Prevention and Treatment
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