Retention among ART patients in the Highlands of Papua New Guinea: evaluating the PAPUA model

• Published in: Journal of acquired immune deficiency syndromes (1999) Vol. 65; no. 2; p. e67
• Main Authors: Das, Sarthak, Carmone, Andy, Franke, Molly F, Frank, Dale, Kiromat, Hannelly, Kaima, Petronia, Kiromat, Mobumo
• Format: Journal Article
• Language: English
• Published: United States 01.02.2014
• Subjects: Adult; Anti-Retroviral Agents - therapeutic use; Antiretroviral Therapy, Highly Active; Female; HIV Infections - drug therapy; Humans; Male; Medication Adherence - statistics & numerical data; Papua New Guinea; Papua New Guinea
• ISSN: 1944-7884
• DOI: 10.1097/QAI.0b013e3182a14f7e

Despite more than 10,000 patients on antiretroviral therapy (ART), there remains a dearth of operational research in Papua New Guinea related to HIV service delivery. This study examined the effectiveness of a locally developed model of HIV service delivery called PAPUA (Patient and Provider Unified Approach) in the Highlands of Papua New Guinea. The model emphasizes coordinated patient and provider support along with decentralized services to rural districts in the Highlands. We conducted a chart review among HIV-infected adults on ART at clinics in Eastern Highlands Province, where the PAPUA model was implemented in addition to the standard of care, and in Western Highlands Province, where the standard of care was implemented. We calculated yearly retention rates and used multivariable Cox proportional hazards regression analyses to compare retention rates across the provinces. Data for 2457 patients from the 2 provinces were analyzed. Among patients receiving ART under the PAPUA model in Eastern Highlands, the 12-, 24-, 36-, and 48-month retention proportions were 0.79, 0.73, 0.68, and 0.63, respectively. When we compared retention probabilities across the 2 provinces, patients receiving care under the PAPUA model had a 15% lower rate of attrition from care during the first 4 years of ART (hazard ratio, 0.85; 95% confidence interval: 0.74 to 0.99; P = 0.03), after adjusting for age, gender, and year of enrollment. The PAPUA model seems to be a promising intervention although it is inextricably linked to the limitations posed by a resource-constrained health system.