Table 2.
Crude odds ratio for program-level factors associated with low median CD4 cell counts among cohorts of patients initiating antiretroviral therapy.
| Total number of cohorts [n (%)] | Median cohort CD4 cell count <111 cells/μl [n (%)] | Median cohort CD4 cell count ≥111 cells/μl [n (%)] | Odds ratio (95% CI) | |
|---|---|---|---|---|
| 1690 (100) | 422 (25) | 1268 (75) | ||
| Site characteristics | ||||
| Setting | ||||
| Rural | 581 (34) | 107 (25) | 474 (37) | 1 |
| Urban | 1109 (66) | 315 (75) | 794 (63) | 1.8 (1.2–2.6) |
| Type of site | ||||
| Primary | 585 (35) | 121 (29) | 464 (37) | 1 |
| Secondary | 988 (58) | 276 (65) | 712 (56) | 1.5 (1.0–2.2) |
| Tertiary | 117 (7) | 25 (6) | 92 (7) | 1.0 (0.46–2.4) |
| PMTCT program | ||||
| Onsite | 1504 (89) | 383 (91) | 1121 (89) | 1 |
| Offsite | 169 (10) | 30 (7) | 139 (11) | 0.63 (0.35–1.1) |
| Unaffiliated with a PMTCT program | 15 (1) | 9 (2) | 6 (0.5) | 4.4 (1.6–12.4) |
| VCT service | ||||
| Onsite | 1619 (96) | 413 (98) | 1206 (95) | 1 |
| Offsite | 60 (4) | 5 (1) | 55 (4) | 0.27 (0.15–0.47) |
| Unaffiliated with a VCT program | 6 (0.4) | 3 (1) | 3 (1) | 2.9 (1.1–7.5) |
| TB treatment program | ||||
| Onsite | 1400 (83) | 379 (90) | 1021 (81) | 1 |
| Offsite | 166 (10) | 24 (6) | 142 (11) | 0.46 (0.27– 0.78) |
| Unaffiliated with a TB program | 17 (1) | 8 (2) | 9 (1) | 2.4 (0.37– 15.7) |
| Not reported | 107 (6) | 11 (3) | 96 (8) | 0.31 (0.12–0.80) |
| CD4 testing | ||||
| Offsite | 924 (55) | 190 (45) | 734 (58) | 1 |
| Onsite | 762 (45) | 229 (55) | 533 (42) | 1.7 (1.2–2.3) |
| Program characteristics | ||||
| Query patients about family members’ HIV status | ||||
| No | 621 (37) | 167 (40) | 454 (36) | 1 |
| Yes | 1069 (63) | 255 (60) | 814 (64) | 0.85 (0.64–1.1) |
| Testing or referring to VCT | ||||
| No | 575 (34) | 155 (37) | 420 (33) | 1 |
| Yes | 1115 (66) | 267 (63) | 848 (67) | 0.85 (0.64–1.1) |
| Outreach for missed visits | ||||
| Not present | 642 (38) | 184 (44) | 458 (36) | 1.7 (1.2–2.4) |
| Pre-ART and ART | 770 (46) | 148 (35) | 622 (49) | 1 |
| ART patients only | 264 (16) | 86 (21) | 178 (14) | 2.0 (1.3–3.2) |
| Peer education access | ||||
| No | 623 (37) | 147 (35) | 476 (38) | 1 |
| Yes | 1054 (63) | 272 (65) | 782 (62) | 1.1 (0.82–1.6) |
| No. of adherence support programs | ||||
| 0–3 | 548 (32) | 194 (46) | 354 (28) | 2.4 (1.6–3.7) |
| 4–5 | 691 (41) | 144 (34) | 547 (43) | 1.2 (0.74–1.8) |
| ≥6 | 451 (27) | 84 (20) | 367 (29) | 1 |
| Program burden | ||||
| Cohort size | ||||
| ≤19 | 423 (25) | 104 (25) | 319 (25) | 1.0 (0.67–1.7) |
| 20–42 | 425 (25) | 93 (22) | 332 (26) | 0.91 (0.58–1.4) |
| 43–88 | 406 (24) | 122 (29) | 284 (22) | 1.4 (0.86–2.2) |
| ≥89 | 436 (26) | 103 (24) | 333 (26) | 1 |
| Cumulative number patients in care | ||||
| <100 | 239 (14) | 61 (15) | 178 (44) | 0.96 (0.59– 1.6) |
| 100–199 | 303 (18) | 80 (19) | 223 (18) | 1 |
| 200–499 | 463 (27) | 103 (25) | 360 (28) | 0.80 (0.54–1.2) |
| >500 | 682 (40) | 176 (42) | 506 (40) | 0.97 (0.65–1.5) |
| Ratio of ART patients to total care population | ||||
| ≤35 | 410 (25) | 110 (26) | 300 (24) | 1 |
| 36–45 | 431 (26) | 95 (23) | 336 (27) | 0.77 (0.50–1.2) |
| 46–55 | 432 (26) | 109 (26) | 323 (26) | 0.92 (0.60– 1.4) |
| ≥56 | 399 (24) | 105 (25) | 294 (23) | 0.97 (0.66–1.4) |
| Number of providers per 1000 patients in HIV care | ||||
| <4 | 433 (26) | 125 (30) | 308 (24) | 1.7 (1.1–2.6) |
| 4–9 | 436 (26) | 117 (28) | 319 (25) | 1.5 (0.98–2.3) |
| 9.1–18 | 389 (23) | 95 (23) | 294 (23) | 1.3 (0.87–2.0) |
| >18 | 432 (26) | 85 (20) | 347 (27) | 1 |
ART, antiretroviral therapy; CI, confidence interval; PMTCT, prevention of mother-to-child transmission; TB, tuberculosis; VCT, voluntary counseling and testing.