ArticlePloS one2012
Treatment initiation, program attrition and patient treatment outcomes associated with scale-up and decentralization of HIV care in rural Malawi.
Article in PloS one, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 5 of them syntheses that pooled it.
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Who cites it
20 citing papers in PubMed, 5 syntheses or guidelines pooled it, 34 citations in OpenAlex.
- The effects of decentralising antiretroviral therapy care delivery on health outcomes for adolescents and young adults in low- and middle-income countries: a systematic review.Global health action · 2019Pooled it
- Specification of implementation interventions to address the cascade of HIV care and treatment in resource-limited settings: a systematic review.Implementation science : IS · 2017Pooled it
- Pooled it
- Pooled it
- Decentralising HIV treatment in lower- and middle-income countries.The Cochrane database of systematic reviews · 2013Pooled it
- Temporal trends in pre-ART patient characteristics and outcomes before the test and treat era in Central Kenya.BMC infectious diseases · 2021Article
- Barriers and coping mechanisms to accessing healthcare during the COVID-19 lockdown: a cross-sectional survey among patients with chronic diseases in rural Rwanda.BMC public health · 2021Article
- Retention in care among clinically stable antiretroviral therapy patients following a six-monthly clinical consultation schedule: findings from a cohort study in rural Malawi.Journal of the International AIDS Society · 2018Article
- Identifying models of HIV care and treatment service delivery in Tanzania, Uganda, and Zambia using cluster analysis and Delphi survey.BMC health services research · 2017Article
- Article
- Social and clinical attributes of patients who restart antiretroviral therapy in central and Copperbelt provinces, Zambia: a retrospective longitudinal study.BMC public health · 2016Article
- Closer to 90-90-90. The cascade of care after 10 years of ART scale-up in rural Malawi: a population study.Journal of the International AIDS Society · 2016Article
- Enhancing linkage and retention in HIV care: a review of interventions for highly resourced and resource-poor settings.Current HIV/AIDS reports · 2014Review
- Improved retention of patients starting antiretroviral treatment in Karonga District, northern Malawi, 2005-2012.Journal of acquired immune deficiency syndromes (1999) · 2014Article
- Article
- Treatment retention and care transitions during and after the scale-up of HIV care and treatment in Northern Tanzania.AIDS care · 2014Observational
- Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared.Journal of the International AIDS Society · 2013Article
- Decentralised paediatric HIV care in Ethiopia: a comparison between outcomes of patients managed in health centres and in a hospital clinic.Global health action · 2013Article
- Paediatric HIV care in sub-Saharan Africa: clinical presentation and 2-year outcomes stratified by age group.Tropical medicine & international health : TM & IH · 2013Article
- Task-sharing of HIV care and ART initiation: evaluation of a mixed-care non-physician provider model for ART delivery in rural Malawi.PloS one · 2013Article
Corrections and comments
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Authors and funding
9 authors at 3 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo describe patient antiretroviral therapy (cART) outcomes associated with intensive decentralization of services in a rural HIV program in Malawi.
methodsLongitudinal analysis of data from HIV-infected patients starting cART between August 2001 and December 2008 and of a cross-sectional immunovirological assessment conducted 12 (±2) months after therapy start. One-year mortality, lost to follow-up, and attrition (deaths and lost to follow-up) rates were estimated with exact Poisson 95% confidence intervals (CI) by type of care delivery and year of initiation. Association of virological suppression (<50 copies/mL) and immunological success (CD4 gain ≥100 cells/µL), with type of care was investigated using multiple logistic regression.
resultsDuring the study period, 4322 cART patients received centralized care and 11,090 decentralized care. At therapy start, patients treated in decentralized health facilities had higher median CD4 count levels (167 vs. 130 cell/µL, P<0.0001) than other patients. Two years after cART start, program attrition was lower in decentralized than centralized facilities (9.9 per 100 person-years, 95% CI: 9.5-10.4 vs. 20.8 per 100 person-years, 95% CI: 19.7-22.0). One year after treatment start, differences in immunological success (adjusted OR=1.23, 95% CI: 0.83-1.83), and viral suppression (adjusted OR=0.80, 95% CI: 0.56-1.14) between patients followed at centralized and decentralized facilities were not statistically significant.
conclusionsIn rural Malawi, 1- and 2-year program attrition was lower in decentralized than in centralized health facilities and no statistically significant differences in one-year immunovirological outcomes were observed between the two health care levels. Longer follow-up is needed to confirm these results.
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