Socio-economic support reduces non-retention in a comprehensive, community-based antiretroviral therapy program in Uganda

OBJECTIVES: We evaluated the benefit of socio-economic support (S-E support), comprised of various financial and non-financial services that are available based on assessment of need, in reducing mortality and lost to follow-up (LTFU) at Reach Out Mbuya (ROM), a community-based, ART program in Uganda. DESIGN: Retrospective observational cohort data from adult patients enrolled between May 31, 2001 and May 31, 2010 were examined. METHODS: Patients were categorised into none, one, and two or more S-E support based on the number of different S-E support services they received. Using Cox proportional hazards regression we modelled the association between S-E support and mortality or LTFU. Kaplan-Meir curves were fitted to examine retention functions stratified by S-E support. RESULTS: In total, 6645 patients were evaluated. After 10 years, 2700 (41%) were retained. Of the 3954 not retained, 2933 (67%) were LTFU and 1021 (23%) had died. After 1, 2, 5 and 10 years, the risks of LTFU or mortality in patients who received no S-E support were significantly higher than those who received some S-E support. In adjusted hazards ratios, patients who received no S-E support were 1.5-fold (1.39-1.64) and 6.7-fold (5.56-7.69) more likely to get LTFU compared to those who received one or two+S-E support respectively. Likewise, patients who received no S-E support were 1.5-fold (CI: 1.16-1.89) and 4.3-fold (CI: 2.94-6.25) more likely to die compared to those who received one or two or more S-E support respectively. CONCLUSIONS: Provision of S-E support reduced LTFU and mortality, suggesting the value of incorporating such strategies for promoting continuity of care.