Attrition in HIV Care Attrition in HIV Care: Key Operational Challenge in implementing HIV Care and Treatment in Tanzania G R Somi _________ Ministry of Health and Social Welfare National AIDS control Programme, Tanzania

Background Implementation of first National HIV Care and Treatment Plan (NCTP) started October 2004, by end of that year, 123’147 (5%) of estimated 2,636,785 PLHIV were enrolled in care. By Dec 2007 a cumulative total of 116,444 patients were on ART Between 21-30% of estimated PLHIV in Tanzania had enrolled in CTC by Dec ART Coverage for adults in Tanzania mainland had reached between 63% and 83% of PLHIV in need of ART in 2009.

Clinic Attendances

Drugs Picking Up

Retention in Care Between 74% to 78% of adults and 79% to 83% of children are on treatment at the end of first year on ART. This proportion dropped to between 65% and 70% in adults and to between 72% to 77% in children in the second year on ART In the first year (on ART) 10% of patients are reported to have died and, 25% to have dropped out, i.e. No Longer On Treatment (NLOT)/ Not attending the clinics

Retention by age, sex and Baseline CD4 Count

Cumulated risk of NLOT per 100 persons initiating treatment

Attrition

Research/Discussion Questions? For what reasons do we loose our patients from ART Initiations ? (care giver/receivers) What are the characteristics of persons dropping out from HIV care and treatment? What are the predictors of attrition? What are the individual and public health outcomes of patients who are lost from care?

Research/Discussion Questions? What could be the most appropriate operational definition of Loss to Follow-up from HIV care? Are there simple but effective models of patient follow up in resource limited settings? How do we sustainably institute patient TRACING MECHANISMS to document the true outcomes of ART and to encourage patients to return to care in the case of default?