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Spatial Analysis of Antiretroviral Therapy Attrition Among Adults in Zimbabwe HIV: Geo-Additive Bayesian Survival Models

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Health and Medical Geography in Africa

Part of the book series: Global Perspectives on Health Geography ((GPHG))

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Abstract

This study aims to describe the spatial heterogeneity of antiretroviral therapy (ART) attrition and identify the hot spots for ART attrition and its correlates before the “treat all” strategy to come up with interventions that strengthen ART retention in Zimbabwe. Secondary data analysis was conducted using individual-level data. A Bayesian geo-additive survival model was utilised, which simultaneously models the non-linear functions of numeric covariates and the baseline time with the spatial effects at the district level adjusting for the fixed effects. The percentage of ART attrition was 30.6% (n = 114,022). The risk of attrition increases with an increase in the number of years on ART. Those enrolled at a provincial/referral (risk ratio (RR) = 2.25; 95% credible interval (CrI): 2.211 to 2.301) or district/mission (RR = 2.5; 95%CrI: 2.394 to 2.63) (reference:primary health care) and tuberculosis-infected patients (RR = 3.589; 95%CrI: 3.291 to 3.911) had an increased risk of ART attrition. The 20-year-olds had the highest risk of ART attrition. There was a distinct structured spatial variation in ART attrition along the Beitbridge-Harare band. Differentiated adherence counselling for adolescents, implementation of strategies for managing patients with tuberculosis coinfection and efficient tracking of LTFU clients are crucial to minimise ART attrition; hence, optimising the benefits of the HIV “treat all” strategy.

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Acknowledgements

Our acknowledgements go to the Ministry of Health and Child Care, AIDS/TB Units Department for support in data compilation and extraction for this study. We also thank the Division of Epidemiology and Biostatistics at the School of Public Health for their assistance in getting ethical approval for this study.

Competing Interests

None declared

Data Sharing Statement

The data used for this study can be found from a third party through an application process to the Zimbabwe Ministry of Health and Child Care through the HIV/AIDS Unit which oversees the data collection and compilation process for the ART programme; therefore, the data is not publicly available.

Author’s Contribution

ZMZ and EM were responsible for the conceptualisation of this paper, and ZMZ performed all the data management, cleaning and analysis. EM oversaw the statistical analysis process. ZMZ, EM, JT and TC contributed to the analysis of the results. ZMZ drafted the manuscript/book chapter. JT, TC and EM reviewed the manuscript for intellectual content. All authors reviewed the final version for submission.

Funding

This work was supported by the Developing Excellence in Leadership, Training and Science (DELTAS) Africa Initiative Sub-Saharan Africa Consortium for Advanced Biostatistics (SSACAB) [Grant No. DEL-15-005]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS) Alliance for Accelerating Excellence in Science in Africa (AESA) and is supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [Grant No. 107754/Z/15/Z] and the United Kingdom government. The views expressed in this publication are those of the authors and not necessarily those of the AAS, NEPAD Agency, Wellcome Trust, the UK government or the Ministry of Health and Child Care, Zimbabwe. This work was also supported by the Wits University Research Committee (URC) [Grant number: URC-2021].

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Authors and Affiliations

  1. Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Zvifadzo Matsena Zingoni

  2. Center for Biomedical Modeling, Department of Psychiatry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA

    Zvifadzo Matsena Zingoni

  3. Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Tobias F. Chirwa & Eustasius Musenge

  4. Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK

    Jim Todd

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  1. Zvifadzo Matsena Zingoni
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  2. Tobias F. Chirwa
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  4. Eustasius Musenge
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Corresponding author

Correspondence to Zvifadzo Matsena Zingoni .

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Editors and Affiliations

  1. Department of Geography, University of Nigeria, Nsukka, Nigeria

    Yemi Adewoyin

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Matsena Zingoni, Z., Chirwa, T.F., Todd, J., Musenge, E. (2023). Spatial Analysis of Antiretroviral Therapy Attrition Among Adults in Zimbabwe HIV: Geo-Additive Bayesian Survival Models. In: Adewoyin, Y. (eds) Health and Medical Geography in Africa. Global Perspectives on Health Geography. Springer, Cham. https://doi.org/10.1007/978-3-031-41268-4_6

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