Retention in HIV Care and Predictors of Attrition from Care among HIV-Infected Adults Receiving Combination Anti-Retroviral Therapy in Addis Ababa

Mekuria, Legese A.; Prins, Jan M.; Yalew, Alemayehu W.; Sprangers, Mirjam A. G.; Nieuwkerk, Pythia T.

doi:10.1371/journal.pone.0130649

Cited by 35 publications

(33 citation statements)

References 42 publications

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“…In contrast to other settings in sub-Saharan Africa in which men have lower retention rates than women[7–10, 12, 13, 17, 18, 34], we did not observe any significant gender disparity. The streamlined care system employed by the clinics, which decreased the frequency and improved the efficiency of visits, could have particularly benefited men by reducing any disruption to employment or other work.…”

Section: Discussioncontrasting

confidence: 99%

High levels of retention in care with streamlined care and universal test and treat in East Africa

Brown

Havlir

Ayieko

et al. 2016

Aids

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Objective We sought to measure retention in care and identify predictors of non-retention among patients receiving ART with streamlined delivery during the first year of the ongoing SEARCH “test-and-treat” trial (NCT 01864603) in rural Uganda and Kenya. Design Prospective cohort of patients in the intervention arm of the SEARCH Study. Methods We measured retention in care at 12 months among HIV-infected adults who linked to care and were offered ART regardless of CD4 cell count, following community-wide HIV-testing. Kaplan-Meier estimates and Cox proportional hazards modeling were used to calculate the probability of retention at one year and identify predictors of non-retention. Results Among 5,683 adults (age ≥ 15) who linked to care, 95.5% (95% CI: 92.9 – 98.1%) were retained in care at 12 months. The overall probability of retention at one year was 89.3% (95% CI: 87.6 – 90.7%) among patients newly linking to care and 96.4% (95% CI: 95.8 – 97.0%) among patients previously in care. Younger age and pre-ART CD4 below country treatment initiation guidelines were predictors of non-retention among all patients. Among those newly linking, taking more than 30 days to link to care after HIV diagnosis was additionally associated with non-retention at one year. HIV viral load suppression at 12 months was observed in 4,227/4736 (89%) of patients retained with valid viral load results. Conclusion High retention in care and viral suppression after 1 year were achieved in a streamlined HIV care delivery system in the context of a universal test-and-treat intervention.

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Section: Discussioncontrasting

confidence: 99%

High levels of retention in care with streamlined care and universal test and treat in East Africa

Brown

Havlir

Ayieko

et al. 2016

Aids

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“…We excluded 1589 items for the reasons detailed in Figure . Thirty articles met inclusion criteria . Two studies reported results for children and adults separately.…”

Section: Resultsmentioning

confidence: 99%

Outcomes of HIV‐positive patients lost to follow‐up in African treatment programmes

Zürcher

Mooser

Anderegg

et al. 2017

Tropical Med Int Health

113

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OBJECTIVE The retention of patients on antiretroviral therapy (ART) is key to achieving global targets in response to the HIV epidemic. Loss to follow-up (LTFU) can be substantial, with unknown outcomes for patients lost to ART programmes. We examined changes in outcomes of patients LTFU over calendar time, assessed associations with other study and programme characteristics and investigated the relative success of different tracing methods. METHODS We performed a systematic review and logistic random-effects meta-regression analysis of studies that traced adults or children who started ART and were LTFU in sub-Saharan African treatment programmes. The primary outcome was mortality, and secondary outcomes were undocumented transfer to another programme, treatment interruption and the success of tracing attempts. RESULTS We included 32 eligible studies from 12 countries in sub-Saharan Africa: 20 365 patients LTFU were traced, and 15 708 patients (77.1%) were found. Compared to telephone calls, tracing that included home visits increased the probability of success: the adjusted odds ratio (aOR) was 9.35 (95% confidence interval [CI] 1.85–47.31). The risk of death declined over calendar time (aOR per 1-year increase 0.86, 95% CI 0.78–0.95), whereas undocumented transfers (aOR 1.13, 95% CI 0.96–1.34) and treatment interruptions (aOR 1.31, 95% CI 1.18–1.45) tended to increase. Mortality was lower in urban than in rural areas (aOR 0.59, 95% CI 0.36–0.98), but there was no difference in mortality between adults and children. The CD4 cell count at the start of ART increased over time. CONCLUSIONS Mortality among HIV-positive patients who started ART in sub-Saharan Africa, were lost to programmes and were successfully traced has declined substantially during the scale-up of ART, probably driven by less severe immunodeficiency at the start of therapy.

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“…Lower baseline CD4 counts or higher WHO stage of the disease was usually associated with higher rates of attrition [34], however in a number of articles, the authors noted that higher CD4 counts were related to poorer retention in care [27, 36]. Koole et al [30] and Mekuria et al [31] found that those with a poorer level of functionality (e.g. those who were bedridden) were also less likely to remain retained in medical care.…”

Section: Resultsmentioning

confidence: 99%

Predictors of Adult Retention in HIV Care: A Systematic Review

2016

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A systematic literature review was conducted to identify predictors of poor adult retention in HIV medical care in developed and developing countries. An electronic search was conducted with MEDLINE (OVID), PubMED, EBSCO, SCOPUS, and Cochrane databases, as well as manual searches. Original, quantitative, adult studies in English, published between 1995 and 2015 were included. Only those with a focus on predictors of retention in care were reported on. Of the 345 articles identified, thirty were included following an independent assessment by two raters. In developed countries, the most frequently cited predictors of poor retention were active substance use and demographic factors. In developing countries, physical health factors were most frequently associated with poor retention in care. The results from this review suggests primary concerns for poor retention include substance use and physical health factors. Other psychosocial factors, such as psychiatric illness and social/welfare factors, were also found to be relevant.

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Retention in HIV Care and Predictors of Attrition from Care among HIV-Infected Adults Receiving Combination Anti-Retroviral Therapy in Addis Ababa

Cited by 35 publications

References 42 publications

High levels of retention in care with streamlined care and universal test and treat in East Africa

High levels of retention in care with streamlined care and universal test and treat in East Africa

Outcomes of HIV‐positive patients lost to follow‐up in African treatment programmes

Predictors of Adult Retention in HIV Care: A Systematic Review

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