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In Buhera, it was found that the patients initiated and followed up in the health centres had a 50% overall decrease in attrition hazard compared to those in the hospital (aHR 0.50, 95%CI 0.45-0.59; p-value <0.001).
In Thyolo, the attrition hazard was higher in the health centres than in the hospital after adjusting for age, gender, ART eligibility and start of ART year (aHR 1.59, 95%CI 1.25-2.09, p-value <0.001).
The patients initiated on ART in the hospital and later referred to the health centres had a lower attrition hazard compared to those initiated on ART in the health centres (aHR 1.77, 95%CI 1.17-2.69, p-value 0.007).
Lower attrition hazard was also observed among adults who attended health facilities that had longer-standing performance-based financing [since 2004 2006], aHR 0.8 [95% CI: 0.6-0.9], compared to patients attending health facilities where performance based financing had began more recently [2007 2008].
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Adults who attended health facilities with a longer duration of performance based financing had a lower hazard attrition in our analysis.
Particular attention will be paid to reducing the problems of attrition and the hazards of multiplicity.
Notably, patients whose CD4+ counts at ART initiation were missing had similar hazard of attrition to the patients with the lowest CD4+ counts.
The most significant factor associated with increased hazard of attrition in our study was starting ART while admitted within an in-patient ward.
The hazard of attrition was lower among adults whose CD4+ count at ART initiation was 200 cells/μL or greater, aHR 0.8 [95% CI: 0.6-1.0], compared to those who initiated ART with CD4+ counts below 200 cells/μL.
A higher hazard of attrition was also observed among men: aHR 1.4 [95% CI: 1.0-1.8] than women; and adults attending urban health facilities: aHR 1.4 [95% CI: 1.1-1.8] compared to those attending rural facilities.> -wrap-foot> *Facility ownership variable (public vs faith based) excluded from the model due to collinearity with facility level variable.
Compared to adults who initiated ART 18 months earlier, adults who initiated ART 12 months earlier had higher hazard of attrition: aHR 1.8 [95% CI: 1.3-2.5]; but no significant difference was observed with adults who had initiated ART in the previous 6 months: aHR 1.3 [95% CI: 0.9 – 1.9].
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com