Comparison of Antiretroviral Treatment outcomes for a General Hospital Versus that of Health Centers: a Retrospective Cohort Study in Southern – Central Oromia
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Date
2010-06
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Addis Abeba Universty
Abstract
Background: - Although antiretroviral treatment (ART) services scaling up is being practiced in the country since the last five years, documented evidence that shows the difference in the treatment outcomes between health center and hospital is not available.
Objective: - To compare the survival rate and antiretroviral treatment outcome among ART naïve patients in a general hospital versus that of health centres and to assess determinants affecting the outcome in both settings.
Design: - Retrospective cohort study supported by qualitative approach was conducted using secondary data from medical records of ART naïve patients collected between October 2006 and January 2010. The study compared the treatment outcome between health centers and a general hospital in southern central Oromia regional state. Univariate and multivariate analyses were implemented using Kaplan Meier and Cox proportional hazard models.
Results: - A total of 1,895 (1307 hospital and 588 health center) patient records were followed for 27,990 person-month. During the study period 172 (9.1%) deaths and 235 (12.4%) lost to follow up (LTFU) were recorded. The incidence density of death among ART naïve patients was 6.2 per 100 person-months and incidence of LTFU was 8.4 per 1000 person per month of observation. Risks of death and LTFU from ART treatment were the same between health centre and hospital HIV/AIDS patients. Independent predictors of risk death and LTFU (failure) for both categories of patients include male sex; AHR 1.4 (95%CI 1.1, 1.7), baseline performance scale three/four; adjusted hazard ratio (AHR) 2.4 (95%CI 2.0, 3.0); advanced disease stage; AHR 2.8 (95%CI 2.3, 3.4), baseline WHO stage, AHR 1.3 (95%CI 1.0, 1.6) and fair to poor adherence to ART; AHR 3.4 (95%CI 2.8, 5.2). Other socio-demographic and baseline variables had no associated with risks.
Conclusion and Recommendation: - The ART service scaling up to health centres did not compromise the treatment outcomes in adult ART naïve patients. Important predictors of risk of death and lose to follow up among HIV/AIDS patients on ART were having base line performance scale three/four, being male, having advanced disease and being fair to poor adherent to ART. Therefore, HIV/AIDS patients should be educated and encouraged to start the treatment in either facility as early as possible.
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Comparison of Antiretroviral Treatment outcomes for a General Hospital Versus that of Health Centers