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Barrot H. Lambdin, PhD, MPH Director of Implementation Science Pangaea Global AIDS Foundation

Barrot H. Lambdin, PhD, MPH Director of Implementation Science Pangaea Global AIDS Foundation. Integration of HIV Treatment in Primary Health Care Centers Impacts Attrition from HIV Treatment Programs in Central Mozambique. Advancing the health and well-being of people most affected by AIDS.

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Barrot H. Lambdin, PhD, MPH Director of Implementation Science Pangaea Global AIDS Foundation

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  1. Barrot H. Lambdin, PhD, MPH Director of Implementation Science Pangaea Global AIDS Foundation Integration of HIV Treatment in Primary Health Care Centers Impacts Attrition from HIV Treatment Programs in Central Mozambique Advancing the health and well-being of people most affected by AIDS

  2. History of ART Scale-up in Mozambique Patients 218,991 170,198 128,330 88,211 31% In RLS 44,100 53% Coverage 18,956 7,456 3,314

  3. History of ART Scale-up in Mozambique Clinics Patients ART Integrated with PHC Clinics 31% In RLS 53% Coverage National ART Program

  4. Study Design, Setting and Population • Retrospective cohort study of patients initiating ART in the national ART program (Jan 06–Jun 08) • Exclusion Criteria: • <15 years of age • Transfer in • Pregnancy • Post Historical Events–Flooding & Temporary Closure • 18 HIV care and treatment clinics managed by MOH in Manica or Sofala Province • Standardized approach for care delivery, patient tracing and data recording • Routine Clinic Databases

  5. Methods • Exposures • Covariates • Clinic Model: Vertical vs. Integrated • Clinic Location: Urban vs. Rural • Clinic Experience: 1st 6-months vs. After • Pre-ART CD4 Count • Pre-ART WHO Stage • Age • Sex • Education • Year of Initiation • Pharmacy Staff Burden • Outcomes • Time until Attrition: Lost to Follow-up or Mortality • Concern for Differential Misclassification • Analysis:Cox proportional hazards models • Accounted for clinic-level clustering (robust variances)

  6. Results: Study Population • 9,120 person-years • Attrition Rate: 39.22 per 100 py Initiated Treatment: 15,232

  7. Results: Demographic Characteristics Age Sex 36% In RLS

  8. Results: Clinical Characteristics CD4 Count WHO Stage 36% In RLS

  9. Results: Clinic Factors and Attrition

  10. Results: Clinic Factors and Attrition Integrated Rural 1st 6 Months Urban Vertical Post 1st 6 Months

  11. Strengths & Limitations • Strengths • Standardization of Protocols • Care delivery • Patient tracing • Data Recording • High quality data • Limitations • Observational Study • Unable to adjust for all patient and clinic characteristics • Generalizeability

  12. Conclusions • Integrating HIV services into PHC dramatically expanded coverage • However, patients attending integrated clinics have a higher risk of attrition • Need to address the obstacles patients face in the integrated setting • Qualitative Study Theme: Dissatisfaction with Pharmacy in Integrated setting • Lower quality of service • Lack of Privacy

  13. Acknowledgements • Juvenol Amos • Luis Francisco • Fernando Baloi • Pedro Tenete • Mark Micek • James Pfeiffer • Pablo Montoya • Kenny Sherr • Alejandro Soto • Stephen Gloyd

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