Improved retention of patients starting antiretroviral treatment in Karonga District, northern Malawi, 2005-2012.

摘要: BACKGROUND: Patient retention in antiretroviral therapy (ART) programs remains a major challenge sub-Saharan Africa. We examined whether and why ART care has changed with increasing access. METHODS: Retrospective cohort study combining individual data from registers interview enabling us to link patients across different clinics Karonga District Malawi. recorded information on all adults (>/=15 years) starting between July 2005 August 2012 including those initiating due pregnancy breastfeeding (Option B+). Retention was defined as being alive receiving at the end of study. Predictors attrition were assessed using multivariable Cox proportional hazards model. RESULTS: The number providing increased 1 16 2012. Six-month 73% [95% confidence interval (CI): 71 76] 93% (95% CI: 92 94) when comparing 2005-2006 2011-2012 cohorts 12-month 70% 67 73) 92% 90 93). Over period proportion World Health Organization stage 4 declined 62% 10%. Being man younger than 35 years having more advanced part an earlier independently associated attrition. Women for Option B+ experienced higher women childbearing age other reasons. CONCLUSIONS: In this area dramatically. Improved health decentralization peripheral centers seem be drivers change.