Factors Associated with Retention to Care in an HIV Clinic in Gabon, Central Africa

Janssen, Saskia; Wieten, Rosanne W.; Stolp, Sebastiaan M.; Cremers, Anne Lia; Rossatanga, Elie G.; Klipstein‐Grobusch, Kerstin; Bélard, Sabine; Grobusch, Martin P.

doi:10.1371/journal.pone.0140746

Cited by 30 publications

(37 citation statements)

References 32 publications

(26 reference statements)

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“…Charurat et al [28] also noted that those with either low or high baseline CD4 counts were more likely to be lost to follow-up (LTFU). Time of commencing ART was also a factor of interest; Janssen et al [29] found that those who initiated ART early were more likely to remain retained in care, and Ugoji et al [34] further noted that individuals who recently commenced ART, compared to those who initiated more than six months prior, were more likely to be retained in 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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Section: Resultsmentioning

confidence: 99%

Predictors of Adult Retention in HIV Care: A Systematic Review

2016

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“…Based on a systematic review of several studies that have been conducted in low resource settings, key predictors of high attrition include patients with advanced HIV-disease progression [marked by body mass index (BMI) <18 kg/m 2 , baseline CD4 counts <200 cells/mL, World Health Organisation (WHO) Stage - III and IV, poorer level of functionality], male sex, younger age and having lower levels of education [5]. Early ART initiation as measured by shorter time duration between HIV testing and ART initiation has been shown to reduce risk of attrition[6, 7]. Other studies have however shown that those who initiate ART at a higher baseline CD4 may also be prone to attrition [8, 9].…”

Section: Introductionmentioning

confidence: 99%

“…Numerous studies assessed attrition and the effect of different initiatives on treatment outcomes at selected health facilities in resource-limited settings [7,8,10–12]. They mainly reflect the experience of academic, standalone, donor supported or private institutions that generally have better data collection systems, are well financed and have better human resources for health, which may not be generalizable.…”

Section: Introductionmentioning

confidence: 99%

Retention and predictors of attrition among patients who started antiretroviral therapy in Zimbabwe’s National Antiretroviral Therapy Programme between 2012 and 2015

Makurumidze

Mutasa‐Apollo

Decroo

et al. 2019

Preprint

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21Background 22 The last evaluation to assess outcomes for patients receiving antiretroviral therapy (ART) 23 through the Zimbabwe public sector was conducted in 2011, covering the 2007-2010 cohorts. 24 The reported retention at 6, 12, 24 and 36 months were 90. 7%, 78.1%, 68.8% and 64.4%, 25 respectively. We report findings of a follow up evaluation for the 2012-2015 cohorts to assess 26 the implementation & impact of recommendations from this prior evaluation. 27 Methods 28A nationwide retrospective study was conducted in 2016. Multi-stage proportional sampling 29 was used to select health facilities and study participants records. The data extracted from 30 patient manual records included demographic, baseline clinical characteristics and patient 31 outcomes (active on treatment, died, transferred out, stopped ART and lost to follow-up 32 (LFTU)) at 6, 12, 24 and 36 months. The data were analysed using Stata/IC 14.2. Retention 33 was estimated using survival analysis. The predictors associated with attrition were determined 34 using a multivariate Cox regression model. 35 Results 36A total of 3,810 participants were recruited in the study. The median age in years was 35 (IQR: 37 28-42). Overall, retention increased to 92.4%, 86.5%, 79.2% and 74.4% at 6, 12, 24 and 36 38 months respectively. LFTU accounted for 98% of attrition. Being an adolescent or a young 39 adult (aHR 1.41; 95%CI:1.14-1.74), receiving care at primary health care facility (aHR 1.23; 40 95%CI:1.01-1.49), having initiated ART between 2014-2015 (aHR 1.45; 95%CI:1.24-1.69), 41 having WHO Stage 4 (aHR 2.06; 95%CI:1.51-2.81) and impaired functional status (aHR 1.24; 42 95%CI:1.04-1.49) predicted attrition.43 44 Conclusion 45 The overall retention was higher in comparison to the previous 2007--2010 evaluation. Further 46 studies to understand why attrition was found to be higher at primary health care facilities are 47 warranted. Implementation of strategies for managing patients with advanced HIV disease, 48 differentiated care for adolescents and young adults and tracking of LFTU should be prioritised 49 to further improve retention. 50 51 Key words 52 ART outcomes, implementation, low resource setting, differentiated care, Zimbabwe53 54 56 Globally by the end of 2018, there were 37.9 million [32.7 million-44.0 million] people living 57 with HIV (PLHIV) with 61% of these residing in Eastern and Southern Africa (ESA) [1]. Over 58 the past two to three decades, investments in the global HIV response have achieved 59 unprecedented results with the number of new HIV infections significantly reduced from 2.9 60 million [2.3 million-3.8 million] in 1997 to 1.7 million [1.6 million-2.3 million] new infections 61 by 2018 and 23.3 million PLHIV put on treatment globally [1]. Between 2010 and 2018 new 62 HIV infections and deaths decreased by 16% and 33%, respectively [2]. Despite these 63 remarkable achievements, patient attrition and losses to follow-up (LTFU) still remain 64 legitimate threats to the long-term success of antiretroviral ther...

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“…Individual factors including younger age[6–13], male gender[8–18], lower education[16], occupation[11, 17], and mobility[19] have all been associated with lower levels of retention in ART care and could affect retention under the test-and-treat paradigm. Additionally, clinic factors contributing to disengagement in care, including long wait times, negative staff attitudes and frequent visits[9, 20–22] could be exacerbated as ART access is expanded.…”

Section: Introductionmentioning

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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Factors Associated with Retention to Care in an HIV Clinic in Gabon, Central Africa

Cited by 30 publications

References 32 publications

Predictors of Adult Retention in HIV Care: A Systematic Review

Predictors of Adult Retention in HIV Care: A Systematic Review

Retention and predictors of attrition among patients who started antiretroviral therapy in Zimbabwe’s National Antiretroviral Therapy Programme between 2012 and 2015

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

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