ArticleJournal of the International AIDS Society2013
Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared.
Article in Journal of the International AIDS Society, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 6 of them syntheses that pooled it.
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Who cites it
14 citing papers in PubMed, 6 syntheses or guidelines pooled it, 23 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
- Pooled it
- Retention of Adult Patients on Antiretroviral Therapy in Low- and Middle-Income Countries: Systematic Review and Meta-analysis 2008-2013.Journal of acquired immune deficiency syndromes (1999) · 2015Pooled it
- Task shifting from doctors to non-doctors for initiation and maintenance of antiretroviral therapy.The Cochrane database of systematic reviews · 2014Pooled it
- Non-physician clinician provided HIV treatment results in equivalent outcomes as physician-provided care: a meta-analysis.Journal of the International AIDS Society · 2013Pooled it
- Decentralising HIV treatment in lower- and middle-income countries.The Cochrane database of systematic reviews · 2013Pooled it
- Lessons for test and treat in an antiretroviral programme after decentralisation in Uganda: a retrospective analysis of outcomes in public healthcare facilities within the Lablite project.International health · 2020Article
- Implementing an integrated community based health systems strengthening approach to improve HIV survival in Northern Togo.AIDS care · 2020Article
- Article
- When patients fail UNAIDS' last 90 - the "failure cascade" beyond 90-90-90 in rural Lesotho, Southern Africa: aJournal of the International AIDS Society · 2017Article
- Alcohol use and depression: link with adherence and viral suppression in adult patients on antiretroviral therapy in rural Lesotho, Southern Africa: a cross-sectional study.BMC public health · 2016Observational
- Observational
- Estimated age and gender profile of individuals missed by a home-based HIV testing and counselling campaign in a Botswana community.Journal of the International AIDS Society · 2015Article
- Improved retention of patients starting antiretroviral treatment in Karonga District, northern Malawi, 2005-2012.Journal of acquired immune deficiency syndromes (1999) · 2014Article
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Authors and funding
10 authors at 5 institutions in 3 countries.
Funding
Abstract
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.
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