Evidence map›Paper›PMID 29682399›Full record

ArticleJournal of AIDS & clinical research2018

Retention in Differentiated Care: Multiple Measures Analysis for a Decentralized HIV Care and Treatment Program in North Central Nigeria.

Patricia A Agaba, Becky L Genberg, Atiene S Sagay, Oche O Agbaji, Seema T Meloni, Nancin Y Dadem, Grace O Kolawole, Prosper Okonkwo, Phyllis J Kanki, Norma C Ware

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In one paragraph

Article in Journal of AIDS & clinical research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
16citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

16 citing papers in PubMed, 1 synthesis or guideline pooled it.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Patricia A AgabaFaculty of Medical Sciences, University of Jos, Nigeria.
Becky L GenbergJohns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
Atiene S SagayFaculty of Medical Sciences, University of Jos, Nigeria.
Oche O AgbajiFaculty of Medical Sciences, University of Jos, Nigeria.
Seema T MeloniHarvard TH Chan School of Public Health, Boston, MA USA.
Nancin Y DademAPIN Centre, Jos University Teaching Hospital, Jos, Nigeria.
Grace O KolawoleAPIN Centre, Jos University Teaching Hospital, Jos, Nigeria.
Prosper OkonkwoAIDS Prevention Initiative Nigeria Lte, Abuja, Nigeria.
Phyllis J KankiHarvard TH Chan School of Public Health, Boston, MA USA.
Norma C WareHarvard Medical School, Boston MA, USA.

Funding

Mentoring in Qualitative Methods for Patient-Oriented Research on HIV CareK24MH090894 · NIMH · HARVARD MEDICAL SCHOOL · PI WARE, NORMA C · 2010 to 2014
$756k
NIMH NIH HHS K24 MH090894
6 · The paper itself

Abstract

objectiveDifferentiated care refers collectively to flexible service models designed to meet the differing needs of HIV-infected persons in resource-scarce settings. Decentralization is one such service model. Retention is a key indicator for monitoring the success of HIV treatment and care programs. We used multiple measures to compare retention in a cohort of patients receiving HIV care at "hub" (central) and "spoke" (decentralized) sites in a large public HIV treatment program in north central Nigeria.

methodsThis retrospective cohort study utilized longitudinal program data representing central and decentralized levels of care in the Plateau State Decentralization Initiative, north central Nigeria. We examined retention with patient- level (retention at fixed times, loss-to-follow-up [LTFU]) and visit-level (gaps-in-care, visit constancy) measures. Regression models with generalized estimating equations (GEE) were used to estimate the effect of decentralization on visit-level measures. Patient-level measures were examined using survival methods with Cox regression models, controlling for baseline variables.

resultsOf 15,650 patients, 43% were enrolled at the hub. Median time in care was 3.1 years. Hub patients were less likely to be LTFU (adjusted hazard ratio (AHR)=0.91, 95% CI: 0.85-0.97), compared to spoke patients. Visit constancy was lower at the hub (-4.5%, 95% CI: -3.5, -5.5), where gaps in care were also more likely to occur (adjusted odds ratio=1.95, 95% CI: 1.83-2.08).

conclusionDecentralized sites demonstrated better retention outcomes using visit-level measures, while the hub achieved better retention outcomes using patient-level measures. Retention estimates produced by incorporating multiple measures showed substantial variation, confirming the influence of measurement strategies on the results of retention research. Future studies of retention in HIV care in sub-Saharan Africa will be well-served by including multiple measures.

Indexed as

AfricaAntiretroviral therapyDecentralizationDifferentiated HIV CareHIV treatmentmeasureNigeriaRetention

Identifiers

PMID29682399
PMCPMC5909978

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.