Attrition in HIV CareAttrition in HIV Care: Key Operational Challenge in implementing HIV Care and Treatment in Tanzania

G R SomiG R Somi_________

Ministry of Health and Social WelfareNational AIDS control Programme, Tanzania

BackgroundBackground• Implementation of first National HIV Care and Treatment Plan

(NCTP) started October 2004, by end of that year, 123’147 (5%) of estimated 2,636,785 PLHIV were enrolled in care.

• By Dec 2007 a cumulative total of 116,444 patients were on ART

• Between 21-30% of estimated PLHIV in Tanzania had enrolled in CTC by Dec 2009.

• ART Coverage for adults in Tanzania mainland had reached between 63% and 83% of PLHIV in need of ART in 2009.

Clinic AttendancesClinic Attendances

Drugs Picking UpDrugs Picking Up

Retention in CareRetention in Care• Between 74% to 78% of adults and 79% to 83% of

children are on treatment at the end of first year on ART.

• This proportion dropped to between 65% and 70% in adults and to between 72% to 77% in children in the second year on ART

• In the first year (on ART) 10% of patients are reported to have died and, 25% to have dropped out, i.e. No Longer On Treatment (NLOT)/ Not attending the clinics

Retention by age, sex and Baseline CD4 Count

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Baseline 6 month 12 month 18 month 24 month

We

igh

ted

% R

eta

ine

d

Time PointCD4 <50 CD4≥50* Male Female < 30y ≥ 30 y

Cumulated risk of NLOT per 100 Cumulated risk of NLOT per 100 persons initiating treatment persons initiating treatment

2005 2006 2007 2008 2009

Within 1 year 21.3 25.7 23.3 28.7 26.6

By 2 years 28.6 33.4 36 39.8 -

By 3 years 34.8 43.5 46.5 - -

By 4 years 43.9 52.9 - - -

AttritionAttrition

75% 70% 67% 63%

4%5% 6% 8%

16% 20% 23% 25%

0%10%20%30%40%50%60%70%80%90%

100%

6 12 18 24

Perc

enta

ge

Time of visits (Months)

Outcomes Among Adults Initiating ART

Alive, on ART ARVs Status missing Attrition-Dead Attrition-Cause not known

Research/Discussion Questions?Research/Discussion Questions?• For what reasons do we loose our patients from

ART Initiations ? (care giver/receivers)• What are the characteristics of persons

dropping out from HIV care and treatment? • What are the predictors of attrition?• What are the individual and public health

outcomes of patients who are lost from care?

Research/Discussion Questions?Research/Discussion Questions?

• What could be the most appropriate operational definition of Loss to Follow-up from HIV care?

• Are there simple but effective models of patient follow up in resource limited settings? How do we sustainably institute patient TRACING MECHANISMS to document the true outcomes of ART and to encourage patients to return to care in the case of default?