ArticleJournal of acquired immune deficiency syndromes (1999)2014
Improved retention of patients starting antiretroviral treatment in Karonga District, northern Malawi, 2005-2012.
Article in Journal of acquired immune deficiency syndromes (1999), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.
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Who cites it
20 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Retention in HIV Care During Pregnancy and the Postpartum Period in the Option B+ Era: Systematic Review and Meta-Analysis of Studies in Africa.Journal of acquired immune deficiency syndromes (1999) · 2018Pooled it
- Pooled it
- Evaluating the effect of interactive two-way texting on 6-month antiretroviral therapy outcomes: Findings from a randomized controlled trial in Lilongwe, Malawi.PLOS global public health · 2025Article
- Cost-effectiveness analysis of a two-way texting (2wT) intervention to improve ART retention among newly-initiated antiretroviral therapy clients in Malawi.Oxford open digital health · 2024Article
- Observational
- Programmatic outcomes and impact of rapid public sector antiretroviral therapy expansion in adults prior to introduction of the WHO treat-all approach in rural Eswatini.Tropical medicine & international health : TM & IH · 2019Article
- Long-term retention on antiretroviral therapy among infants, children, adolescents and adults in Malawi: A cohort study.PloS one · 2019Article
- Does antiretroviral treatment increase the infectiousness of smear-positive pulmonary tuberculosis?The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease · 2017Article
- Changes in Fertility at the Population Level in the Era of ART in Rural Malawi.Journal of acquired immune deficiency syndromes (1999) · 2017Article
- 'I wanted to safeguard the baby': a qualitative study to understand the experiences of Option B+ for pregnant women and the potential implications for 'test-and-treat' in four sub-Saharan African settings.Sexually transmitted infections · 2017Article
- Sustained 10-year gain in adult life expectancy following antiretroviral therapy roll-out in rural Malawi: July 2005 to June 2014.International journal of epidemiology · 2017Article
- Prevention of mother-to-child transmission of HIV Option B+ cascade in rural Tanzania: The One Stop Clinic model.PloS one · 2017Article
- HIV policy and implementation: a national policy review and an implementation case study of a rural area of northern Malawi.AIDS care · 2016Article
- Article
- Retention in care during the first 3 years of antiretroviral therapy for women in Malawi's option B+ programme: an observational cohort study.The lancet. HIV · 2016Observational
- Determinants of time to antiretroviral treatment initiation and subsequent mortality on treatment in a cohort in rural northern Malawi.AIDS research and therapy · 2016Article
- Reasons for Missing Antiretroviral Therapy: Results from a Multi-Country Study in Tanzania, Uganda, and Zambia.PloS one · 2016Article
- Paediatric HIV: Progress on Prevention, Treatment and Cure.Current pediatrics reports · 2015Article
- Estimated Costs for Delivery of HIV Antiretroviral Therapy to Individuals with CD4+ T-Cell Counts >350 cells/uL in Rural Uganda.PloS one · 2015Article
- Reliability of reporting of HIV status and antiretroviral therapy usage during verbal autopsies: a large prospective study in rural Malawi.Global health actionArticle
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Authors and funding
9 authors.
Funding
Abstract
backgroundPatient retention in antiretroviral therapy (ART) programs remains a major challenge in sub-Saharan Africa. We examined whether and why retention in ART care has changed with increasing access.
methodsRetrospective cohort study combining individual data from ART registers and interview data, enabling us to link patients across different ART clinics in Karonga District, Malawi. We recorded information on all adults (≥15 years) starting ART between July 2005 and August 2012, including those initiating due to pregnancy and breastfeeding (Option B+). Retention in care was defined as being alive and receiving ART at the end of study. Predictors of attrition were assessed using a multivariable Cox proportional hazards model.
resultsThe number of clinics providing ART increased from 1 in 2005 to 16 in 2012. Six-month retention increased from 73% [95% confidence interval (CI): 71 to 76] to 93% (95% CI: 92 to 94) when comparing the 2005-2006 and 2011-2012 cohorts, and 12-month retention increased from 70% (95% CI: 67 to 73) to 92% (95% CI: 90 to 93). Over the study period, the proportion of patients starting ART at World Health Organization stage 4 declined from 62% to 10%. Being a man, younger than 35 years, having a more advanced World Health Organization stage and being part of an earlier cohort were all independently associated with attrition. Women starting ART for Option B+ experienced higher attrition than women of childbearing age starting for other reasons.
conclusionsIn this area, retention in care has increased dramatically. Improved health in patients starting ART and decentralization of ART care to peripheral health centers seem to be the major drivers for this change.
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