Preventing antiretroviral anarchy in sub-Saharan Africa

Influence of gender on loss to follow-up in a large HIV treatment programme in western Kenya

“…Again, targeted interventions, including more frequent scheduled clinic visits and rapid assessment in the clinic, may improve both retention in care and clinical outcomes. 20 Another important study finding is that, despite concerns about the effect of rapidly scaling-up ART in African settings, [21][22][23] retention among our patient population appears to have improved over time. We postulate that this is because AMPATH has expanded by providing more parent and satellite clinics, by offering more comprehensives services and care, such as giving food supplements, 24 and by enhancing community outreach through several mechanisms, including increased use of community health workers, recording detailed locator information on each patient and expanding the peer outreach programme.…”

Development and evaluation of a clinical algorithm to monitor patients on antiretrovirals in resource-limited settings using adherence, clinical and CD4 cell count criteria

“…If patients with viral failure are allowed to continue on first-line ART, then it is likely that resistance mutations will accumulate [4-6] and reduce the effectiveness of second-line ART [41]. …”

Payment for antiretroviral drugs is associated with a higher rate of patients lost to follow-up than those offered free-of-charge therapy in Nairobi, Kenya

“…Keeping the rates of loss to follow-up in ART programmes to a minimum is important to ensure that patients continue treatment in an uninterrupted manner and optimally reap the survival benefits induced by ART (Harries et al, 2001;WHO, 2003). In the cohort that paid for ART, it is reasonable to believe that some patients who started ART might have been unable to sustain it after the first few months, as the ability to pay might have disappeared with time.…”