Background: We report levels and determinants of attrition in Rwanda, one of the few African countries with universal ART access.
Methods: We analyzed data abstracted from health facility records of a nationally representative sample of adults [≥ 18 years] who initiated ART 6, 12, and 18 months prior to data collection; and collected facility characteristics with a health facility assessment questionnaire. Weighted proportions and rates of attrition [loss to follow-up or death] were calculated, and patient- and health facility-level factors associated with attrition examined using Cox proportional hazard models.
Results: 1678 adults initiated ART 6, 12 and 18 months prior to data collection, with 1508 person-years [PY] on ART. Attrition was 6.8% [95% confidence interval [CI] 6.0-7.8]: 2.9% [2.4-3.5] recorded deaths and 3.9% [3.4-4.5] lost to follow-up. Population attrition rate was 7.5/100 PY [6.1-9.3]. Adjusted hazard ratio [aHR] for attrition was 4.2 [3.0-5.7] among adults enrolled from in-patient wards [vs 2.2 [1.6-3.0] from PMTCT, ref: VCT]. Compared to adults who initiated ART 18 months earlier, aHR for adults who initiated ART 12 and 6 months earlier was 1.8 [1.3-2.5] and 1.3 [0.9-1.9] respectively. Male aHR was 1.4 [1.0-1.8]. AHR of adults enrolled at urban health facilities was 1.4 [1.1-1.8, ref: rural health facilities]. AHR for adults with CD4+ ≥ 200 cells/μL vs <200 cells/μL was 0.8 [0.6-1.0]; and adults attending facilities with performance-based financing since 2004-2006 [vs. 2007-2008] had aHR 0.8 [0.6-0.9].
Conclusions: Attrition was low in the Rwandan national program. The above patient and facility correlates of attrition can be the focus of interventions to sustain high retention.
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http://dx.doi.org/10.1186/1471-2458-14-889 | DOI Listing |
Trials
January 2025
Department of Electrical and Computer Engineering, Princeton University, Princeton, 08544, NJ, USA.
Background: Phase-3 clinical trials provide the highest level of evidence on drug safety and effectiveness needed for market approval by implementing large randomized controlled trials (RCTs). However, 30-40% of these trials fail mainly because such studies have inadequate sample sizes, stemming from the inability to obtain accurate initial estimates of average treatment effect parameters.
Methods: To remove this obstacle from the drug development cycle, we present a new algorithm called Trend-Adaptive Design with a Synthetic-Intervention-Based Estimator (TAD-SIE) that powers a parallel-group trial, a standard RCT design, by leveraging a state-of-the-art hypothesis testing strategy and a novel trend-adaptive design (TAD).
BMC Med Educ
January 2025
Department of Physiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
Background: The doctor-patient relationship is essential for effective patient care, yet medical education often neglects to nurture the quality such as empathy during the initial years of training. Doctor-patient relationship is one of the modules taught in first year as part of mandatory AETCOM (Attitude, Ethics, and Communication) course in the undergraduate Indian medical curriculum. Hermeneutics, a method of interpretation, can play a vital role in introducing observational and reflective thinking skills.
View Article and Find Full Text PDFJMIR Mhealth Uhealth
January 2025
HIV Unit, Hospital Civil de Guadalajara, Hospital 278, Guadalajara, 44280, Mexico, 52 3338093219.
Background: HIV continues to be a public health concern in Mexico and Latin America due to an increase in new infections, despite a decrease being observed globally. Treatment adherence is a pillar for achieving viral suppression. It prevents the spread of the disease at a community level and improves the quality and survival of people living with HIV.
View Article and Find Full Text PDFAnal Chim Acta
March 2025
School of Automation, Central South University, 410083, Changsha, China. Electronic address:
In spectral analysis, selecting the right spectral variables is crucial for effective modeling. It reduces data dimensionality, removes irrelevant wavelength points, and improves both the generalization ability and computational efficiency of the model. However, the number of available samples often falls short of the total possible combinations of wavelengths, making variable selection a non-deterministic polynomial-time (NP) hard optimization problem.
View Article and Find Full Text PDFFront Public Health
January 2025
School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
Introduction: HIV self-testing (HIVST) is an innovative strategy that has been shown to increase uptake of HIV testing compared to conventional facility-based testing. HIVST implementation with digital-based supports may help facilitate testing accessibility and linkage to care after a reactive self-test. Economic evidence around community-based implementation of HIVST is growing; however, economic evidence around digital-based HIVST approaches remains limited.
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