ArticlePloS one2017
Distance to care, enrollment and loss to follow-up of HIV patients during decentralization of antiretroviral therapy in Neno District, Malawi: A retrospective cohort study.
Article in PloS one, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers, 1 of them a synthesis that pooled it.
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Who cites it
43 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Strategies for retention of heterosexual men in HIV care in sub-Saharan Africa: A systematic review.PloS one · 2021Pooled it
- Patient perspectives on group problem management plus for adults with major depressive disorder in rural Malawi.Global health action · 2025Trial
- Trial
- The convergence of health system, climate, and social pathways in Malawi's 2022-2024 cholera outbreak - A qualitative assessment.PLoS neglected tropical diseases · 2026Article
- Quantifying the impact of health service delivery barriers on access to healthcare: a case study of antiretroviral therapy in Mali.BMJ global health · 2026Article
- Retention in HIV care before and after implementation of a case management program in Malawi.BMC public health · 2026Article
- Factors Associated With Loss to Follow-Up Among People Living With HIV in a National Tertiary Care Hospital: Protocol and Baseline Analysis of a Prospective Cohort Study.JMIR research protocols · 2026Article
- Incidence and predictors of lost to follow up among children receiving antiretroviral therapy a computing risk regression model.Scientific reports · 2025Article
- Analysis of travel-time to HIV treatment in sub-Saharan Africa reveals inequities in access to antiretrovirals.Communications medicine · 2025Article
- Engaging Councillors to Address Structural and Social Drivers of HIV Infections in Blantyre City: A Formative Study.International journal of health policy and management · 2025Article
- HIV infection during pregnancy in the state of Rio de Janeiro, Brazil, 2021-2023.Revista brasileira de epidemiologia = Brazilian journal of epidemiology · 2025Article
- Article
- Toward enhanced decentralized palliative care services in Neno District, Malawi: a qualitative study.BMC palliative care · 2024Article
- Re-engagement and retention in HIV care after preventive default tracking in a cohort of HIV-infected patients in rural Malawi: A mixed-methods study.PLOS global public health · 2024Article
- Loss to Hospital Follow-Up in Pediatric Cerebral Malaria Survivors: A Case-Control Study.The American journal of tropical medicine and hygiene · 2023Article
- Article
- Associations between treatment burden, self-reported treatment qualities, antiretroviral therapy obtainment, and health-related quality of life among Ugandan PLWH.Cost effectiveness and resource allocation : C/E · 2023Article
- AIDS-related mortality in Pará Province, Brazilian Amazon region: Spatial and temporal analysis.PloS one · 2023Article
- An intervention pilot to facilitate harm reduction service decentralization in Vietnam.Journal of substance abuse treatment · 2023Article
- Development and validation of an instrument for the evaluation of HIV care in Primary Health Care.Revista brasileira de enfermagem · 2023Article
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Authors and funding
11 authors.
Funding
Abstract
HIV/AIDS remains the second most common cause of death in low and middle-income countries (LMICs), and only 34% of eligible patients in Africa received antiretroviral therapy (ART) in 2013. This study investigated the impact of ART decentralization on patient enrollment and retention in rural Malawi. We reviewed electronic medical records of patients registered in the Neno District ART program from August 1, 2006, when ART first became available, through December 31, 2013. We used GPS data to calculate patient-level distance to care, and examined number of annual ART visits and one-year lost to follow-up (LTFU) in HIV care. The number of ART patients in Neno increased from 48 to 3,949 over the decentralization period. Mean travel distance decreased from 7.3 km when ART was only available at the district hospital to 4.7 km when ART was decentralized to 12 primary health facilities. For patients who transferred from centralized care to nearer health facilities, mean travel distance decreased from 9.5 km to 4.7 km. Following a transfer, the proportion of patients achieving the clinic's recommended ≥4 annual visits increased from 89% to 99%. In Cox proportional hazards regression, patients living ≥8 km from a health facility had a greater hazard of being LTFU compared to patients <8 km from a facility (adjusted HR: 1.7; 95% CI: 1.5-1.9). ART decentralization in Neno District was associated with increased ART enrollment, decreased travel distance, and increased retention in care. Increasing access to ART by reducing travel distance is one strategy to achieve the ART coverage and viral suppression objectives of the 90-90-90 UNAIDS targets in rural impoverished areas.
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