ArticleJournal of the International AIDS Society2018
Retention in care among clinically stable antiretroviral therapy patients following a six-monthly clinical consultation schedule: findings from a cohort study in rural Malawi.
Article in Journal of the International AIDS Society, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 3 of them syntheses that pooled it.
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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.
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Who cites it
22 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Exploring Sustainability in the Era of Differentiated HIV Service Delivery in Sub-Saharan Africa: A Systematic Review.Journal of acquired immune deficiency syndromes (1999) · 2021Pooled it
- Strategies for retention of heterosexual men in HIV care in sub-Saharan Africa: A systematic review.PloS one · 2021Pooled it
- Uptake of Appointment Spacing Model of Care and Determinants Among Adult Clients on Antiretroviral Treatment in Ethiopia.Journal of the International Association of Providers of AIDS CarePooled it
- Reducing time to differentiated service delivery for newly-diagnosed people living with HIV in Kigali, Rwanda: a pilot, unblinded, randomized controlled trial.BMC health services research · 2024Trial
- Outcomes of Three- Versus Six-Monthly Dispensing of Antiretroviral Treatment (ART) for Stable HIV Patients in Community ART Refill Groups: A Cluster-Randomized Trial in Zimbabwe.Journal of acquired immune deficiency syndromes (1999) · 2020Trial
- Preferences for Hypertension Care in Malawi: A Discrete Choice Experiment Among People Living with Hypertension, With and Without HIV.AIDS and behavior · 2025Article
- High rate of uncontrolled hypertension among adults receiving integrated HIV and hypertension care with aligned multi-month dispensing in Malawi: results from a cross-sectional survey and retrospective chart review.Journal of the International AIDS Society · 2024Article
- Consistency of Multi-Month Antiretroviral Therapy Dispensing and Association with Viral Load Coverage among Pediatric Clients Living with HIV in Mozambique.Tropical medicine and infectious disease · 2024Article
- Protecting the gains: analysis of HIV treatment and service delivery programme data and interventions implemented in 19 African countries during COVID-19.Journal of the International AIDS Society · 2022Article
- Food insecurity predicts loss to follow-up among people living with HIV in Senegal, West Africa.AIDS care · 2022Article
- eHealth supported multi-months dispensing of antiretroviral therapy: a mixed-methods preference assessment in rural Lesotho.Pilot and feasibility studies · 2022Article
- Article
- Uptake of community- versus clinic-based antiretroviral therapy dispensing in the Central Chronic Medication Dispensing and Distribution program in South Africa.Journal of the International AIDS Society · 2022Observational
- Article
- A controlled study to assess the effects of a Fast Track (FT) service delivery model among stable HIV patients in Lusaka Zambia.PLOS global public health · 2022Article
- Retention on ART and viral suppression among patients in alternative models of differentiated HIV service delivery in KwaZulu-Natal, South Africa.PLOS global public health · 2022Article
- Article
- Investigating the implementation of differentiated HIV services and implications for pregnant and postpartum women: A mixed methods multi-country study.Global public health · 2021Article
- COVID-19 mitigation measures to maintain access to essential health services: new opportunities with long-term benefits.The Pan African medical journal · 2021Article
- Qualitative exploration of perceived benefits of care and barriers influencing HIV care in trans Nzoia, Kenya.BMC health services research · 2020Article
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
introductionLonger intervals between clinic consultations for clinically stable antiretroviral therapy (ART) patients may improve retention in care and reduce facility workload. We assessed long-term retention among clinically stable ART patients attending six-monthly clinical consultations (SMCC) with three-monthly fast-track drug refills, and estimated the number of consultations "saved" by this model of ART delivery in rural Malawi.
methodsStable patients (aged ≥18 years, on first-line ART ≥12 months, CD4 count ≥300 cells/mL
resultsFrom 2008 to 2015, 22,633 clinically stable patients from 11 facilities were eligible for SMCC for at least three months, contributing 74,264 person-years of observation, and 18,363 persons (81%) initiated this model of care. The median time from eligibility to enrolment was 12 months and the median cumulative time on SMCC was 14.5 months. Five years after first SMCC eligibility, cumulative probabilities of retention were 85.5% (95% CI: 84.0% to 86.9%) among early enrollees and 93% (95% CI: 92.8% to 94.0%) among late enrollees. The cumulative probability of retention from first SMCC was 97.0% (95% CI: 96.7% to 97.3%) and 86% (95% CI: 85% to 87%) at one and five years respectively. Among eligible patients initiating SMCC, the adjusted hazards of attrition were 2.4 (95% CI: 2.0 to 2.8) times higher during periods of SMCC discontinuation compared to periods on SMCC. Male sex, younger age, more recent SMCC eligibility and WHO Stage 3/4 conditions in the past year were also independently associated with attrition from SMCC. Approximately 26,000 consultations were "saved" during 2014.
conclusionAfter five years, retention among patients attending SMCC was high, especially among women and older patients, and its scale-up could facilitate universal access to ART.
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