Treatment retention and care transitions during and after the scale-up of HIV care and treatment in Northern Tanzania

Abstract

Decentralization of HIV care is promoted to improve access to antiretroviral therapy in sub-Saharan Africa. This study describes care transitions among HIV-infected persons in Northern Tanzania during a period of rapid decentralization of HIV care and treatment centers (CTCs) from hospitals to local health centers. Between November 2008 and June 2009, 492 HIV-infected patients in established care at two referral hospitals in Moshi, Tanzania, and 262 persons newly diagnosed with HIV were selected for participation in a prospective cohort study entitled Coping with HIV/AIDS in Tanzania. Clinical records and participant self-reports, collected between June and November 2012, were used to describe retention in care and transitions between CTCs during the study period. After a mean follow-up period of 3.5 years, 10% of participants had died, 9% were lost to follow-up, and 11% had moved. Of the remaining participants enrolled from CTCs, more than 90% reported at least one CTC visit during the previous six months, with 98% still in care at the CTC at which they were enrolled. Nearly three out of four newly diagnosed clients listed a referral hospital as their primary CTC. Fewer than 10% of participants ever sought care at another CTC in the study area; nearly 90% of those in care bypassed their closest CTC. Administrative data from all facilities in the study area indicate that new clients, even after the scale-up from 8 CTCs in 2006 to 21 CTCs in 2008, disproportionately selected established CTCs, and client volume at newly approved facilities was highly variable. Despite the decentralization of HIV care and treatment in this setting, many patients continue to bypass their closest CTC to seek care at established facilities. Patient preferences for decentralized HIV care, which may inform optimal resource utilization, are largely unknown and warrant further investigation.

Keywords:

• HIV/AIDS
• antiretroviral therapy
• decentralization
• treatment retention
• Tanzania

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Corrigendum

Acknowledgments

We acknowledge the support provided by the Regional Medical Officer of the Kilimanjaro Region, Dr. Mtumwa Mwako.

Funding

This publication was made possible by the National Institute of Mental Health [grant number 5R01MH078756] and supported by the Duke University Center for AIDS Research (CFAR), an NIH-funded program [grant number 5P30 AI064518]. KL2 RR024127–04 provided salary support for Dr. Reddy. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.

Supplementary Material

Supplementary content is available via the ‘Supplementary’ tab on the article's online page (http://dx.doi.org/10.1080/09540121.2014.882493)

Additional information

Funding

Funding: This publication was made possible by the National Institute of Mental Health [grant number 5R01MH078756] and supported by the Duke University Center for AIDS Research (CFAR), an NIH-funded program [grant number 5P30 AI064518]. KL2 RR024127–04 provided salary support for Dr. Reddy. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.