Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared

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dc.contributor.authorLabhardt, Niklaus Daniel
dc.contributor.authorKeiser, Olivia
dc.contributor.authorSello, Motlalepula
dc.contributor.authorLejone, Thabo Ishmael
dc.contributor.authorPfeiffer, Karolin
dc.contributor.authorDavies, Mary-Ann
dc.contributor.authorEgger, Matthias
dc.contributor.authorEhmer, Jochen
dc.contributor.authorWandeler, Gilles
dc.date.accessioned2021-10-08T07:08:16Z
dc.date.available2021-10-08T07:08:16Z
dc.date.issued2013
dc.description.abstractIntroductionLesotho was among the first countries to adopt decentralization of care from hospitals to nurse-led health centres (HCs) to scale up the provision of antiretroviral therapy (ART). We compared outcomes between patients who started ART at HCs and hospitals in two rural catchment areas in Lesotho.MethodsThe two catchment areas comprise two hospitals and 12 HCs. Patients ≥16 years starting ART at a hospital or HC between 2008 and 2011 were included. Loss to follow-up (LTFU) was defined as not returning to the facility for ≥180 days after the last visit, no follow-up (no FUP) as not returning after starting ART, and retention in care as alive and on ART at the facility. The data were analysed using logistic regression, competing risk regression and Kaplan-Meier methods. Multivariable analyses were adjusted for sex, age, CD4 cell count, World Health Organization stage, catchment area and type of ART. All analyses were stratified by gender.ResultsOf 3747 patients, 2042 (54.5%) started ART at HCs. Both women and men at hospitals had more advanced clinical and immunological stages of disease than those at HCs. Over 5445 patient-years, 420 died and 475 were LTFU. Kaplan-Meier estimates for three-year retention were 68.7 and 69.7% at HCs and hospitals, respectively, among women (p=0.81) and 68.8% at HCs versus 54.7% at hospitals among men (p<0.001). These findings persisted in adjusted analyses, with similar retention at HCs and hospitals among women (odds ratio (OR): 0.89, 95% confidence interval (CI): 0.73–1.09) and higher retention at HCs among men (OR: 1.53, 95% CI: 1.20–1.96). The latter result was mainly driven by a lower proportion of patients LTFU at HCs (OR: 0.68, 95% CI: 0.51–0.93).ConclusionsIn rural Lesotho, overall retention in care did not differ significantly between nurse-led HCs and hospitals. However, men seemed to benefit most from starting ART at HCs, as they were more likely to remain in care in these facilities compared to hospitals.
dc.identifier.apacitationLabhardt, N. D., Keiser, O., Sello, M., Lejone, T. I., Pfeiffer, K., Davies, M., ... Wandeler, G. (2013). Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared. <i>Journal of the International AIDS Society</i>, 16(1), 18616 - 177. http://hdl.handle.net/11427/34538en_ZA
dc.identifier.chicagocitationLabhardt, Niklaus Daniel, Olivia Keiser, Motlalepula Sello, Thabo Ishmael Lejone, Karolin Pfeiffer, Mary-Ann Davies, Matthias Egger, Jochen Ehmer, and Gilles Wandeler "Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared." <i>Journal of the International AIDS Society</i> 16, 1. (2013): 18616 - 177. http://hdl.handle.net/11427/34538en_ZA
dc.identifier.citationLabhardt, N.D., Keiser, O., Sello, M., Lejone, T.I., Pfeiffer, K., Davies, M., Egger, M. & Ehmer, J. et al. 2013. Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared. <i>Journal of the International AIDS Society.</i> 16(1):18616 - 177. http://hdl.handle.net/11427/34538en_ZA
dc.identifier.issn1758-2652
dc.identifier.ris TY - Journal Article AU - Labhardt, Niklaus Daniel AU - Keiser, Olivia AU - Sello, Motlalepula AU - Lejone, Thabo Ishmael AU - Pfeiffer, Karolin AU - Davies, Mary-Ann AU - Egger, Matthias AU - Ehmer, Jochen AU - Wandeler, Gilles AB - IntroductionLesotho was among the first countries to adopt decentralization of care from hospitals to nurse-led health centres (HCs) to scale up the provision of antiretroviral therapy (ART). We compared outcomes between patients who started ART at HCs and hospitals in two rural catchment areas in Lesotho.MethodsThe two catchment areas comprise two hospitals and 12 HCs. Patients ≥16 years starting ART at a hospital or HC between 2008 and 2011 were included. Loss to follow-up (LTFU) was defined as not returning to the facility for ≥180 days after the last visit, no follow-up (no FUP) as not returning after starting ART, and retention in care as alive and on ART at the facility. The data were analysed using logistic regression, competing risk regression and Kaplan-Meier methods. Multivariable analyses were adjusted for sex, age, CD4 cell count, World Health Organization stage, catchment area and type of ART. All analyses were stratified by gender.ResultsOf 3747 patients, 2042 (54.5%) started ART at HCs. Both women and men at hospitals had more advanced clinical and immunological stages of disease than those at HCs. Over 5445 patient-years, 420 died and 475 were LTFU. Kaplan-Meier estimates for three-year retention were 68.7 and 69.7% at HCs and hospitals, respectively, among women (p=0.81) and 68.8% at HCs versus 54.7% at hospitals among men (p<0.001). These findings persisted in adjusted analyses, with similar retention at HCs and hospitals among women (odds ratio (OR): 0.89, 95% confidence interval (CI): 0.73–1.09) and higher retention at HCs among men (OR: 1.53, 95% CI: 1.20–1.96). The latter result was mainly driven by a lower proportion of patients LTFU at HCs (OR: 0.68, 95% CI: 0.51–0.93).ConclusionsIn rural Lesotho, overall retention in care did not differ significantly between nurse-led HCs and hospitals. However, men seemed to benefit most from starting ART at HCs, as they were more likely to remain in care in these facilities compared to hospitals. DA - 2013 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - Journal of the International AIDS Society LK - https://open.uct.ac.za PY - 2013 SM - 1758-2652 T1 - Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared TI - Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared UR - http://hdl.handle.net/11427/34538 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34538
dc.identifier.vancouvercitationLabhardt ND, Keiser O, Sello M, Lejone TI, Pfeiffer K, Davies M, et al. Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared. Journal of the International AIDS Society. 2013;16(1):18616 - 177. http://hdl.handle.net/11427/34538.en_ZA
dc.language.isoeng
dc.publisher.departmentDepartment of Public Health and Family Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.sourceJournal of the International AIDS Society
dc.source.journalissue1
dc.source.journalvolume16
dc.source.pagination18616 - 177
dc.source.urihttps://dx.doi.org/10.7448/IAS.16.1.18616
dc.subject.otherHIV
dc.subject.otherantiretroviral treatment
dc.subject.otherdecentralization
dc.subject.othernurse-based care
dc.subject.otherretention in care
dc.subject.otherrural Southern Africa
dc.subject.othertask shifting
dc.subject.otherAdult
dc.subject.otherAnti-Retroviral Agents
dc.subject.otherCommunity Health Centers
dc.subject.otherFemale
dc.subject.otherHIV Infections
dc.subject.otherHospitals
dc.subject.otherHumans
dc.subject.otherLesotho
dc.subject.otherMale
dc.subject.otherMedication Adherence
dc.subject.otherMiddle Aged
dc.subject.otherRural Population
dc.subject.otherTreatment Outcome
dc.subject.otherAnti-Retroviral Agents
dc.titleOutcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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