Predictors of Adult Retention in HIV Care: A Systematic Review

Bulsara, Shiraze M.; Wainberg, Milton L.; Newton‐John, Toby

doi:10.1007/s10461-016-1644-y

Cited by 106 publications

(99 citation statements)

References 38 publications

(103 reference statements)

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“…Men and non‐pregnant women had the same risk of an unfavourable outcome. Although men in general show worse HIV care outcomes , findings from Eswatini remain inconsistent, with increased and similar risk for men . Adverse treatment outcomes were high for pregnant women under Treat‐All, which is in line with findings from PMTCT B+ and general ART programmes .…”

Section: Discussionsupporting

confidence: 69%

“…Similarly to other settings , low CD4 cell count was associated with an adverse outcome. The association was more pronounced for patients presenting with advanced HIV disease, and the effect of CD4 cell count varied with time under SOC, with higher hazard early during treatment.…”

Section: Discussionmentioning

confidence: 68%

“…Although men in general show worse HIV care outcomes [46,52,53], findings from Eswatini remain inconsistent, with increased and similar risk for men [54][55][56]. Adverse treatment outcomes were high for pregnant women under Treat-All, which is in line with findings from PMTCT B+ and general ART programmes [46,48,57]. Specific interventions supporting pregnant women under Treat-All may be needed to achieve the full benefits of universal ART expansion for this group.…”

Section: Explanation Of Findingsmentioning

confidence: 65%

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HIV programmatic outcomes following implementation of the ‘Treat‐All’ policy in a public sector setting in Eswatini: a prospective cohort study

et al. 2020

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Introduction The Treat‐All policy – antiretroviral therapy (ART) initiation irrespective of CD4 cell criteria – increases access to treatment. Many ART programmes, however, reported increasing attrition and viral failure during treatment expansion, questioning the programmatic feasibility of Treat‐All in resource‐limited settings. We aimed to describe and compare programmatic outcomes between Treat‐All and standard of care (SOC) in the public sectors of Eswatini. Methods This is a prospective cohort study of ≥16‐year‐old HIV‐positive patients initiated on first‐line ART under Treat‐All and SOC in 18 health facilities of the Shiselweni region, from October 2014 to March 2016. SOC followed the CD4 350 and 500 cells/mm3 treatment eligibility thresholds. Kaplan‐Meier estimates were used to describe crude programmatic outcomes. Multivariate flexible parametric survival models were built to assess associations of time from ART initiation with the composite unfavourable outcome of all‐cause attrition and viral failure. Results Of the 3170 patients, 1888 (59.6%) initiated ART under Treat‐All at a median CD4 cell count of 329 (IQR 168 to 488) cells/mm3 compared with 292 (IQR 161 to 430) (p < 0.001) under SOC. Although crude programme retention at 36 months tended to be lower under Treat‐All (71%) than SOC (75%) (p = 0.002), it was similar in covariate‐adjusted analysis (adjusted hazard ratio [aHR] 1.06, 95% CI 0.91 to 1.23). The hazard of viral suppression was higher for Treat‐All (aHR 1.12, 95% CI 1.01 to 1.23), while the hazard of viral failure was comparable (Treat‐All: aHR 0.89, 95% CI 0.53 to 1.49). Among patients with advanced HIV disease (n = 1080), those under Treat‐All (aHR 1.13, 95% CI 0.88 to 1.44) had a similar risk of an composite unfavourable outcome to SOC. Factors increasing the risk of the composite unfavourable outcome under both interventions were aged 16 to 24 years, being unmarried, anaemia, ART initiation on the same day as HIV care enrolment and CD4 ≤ 100 cells/mm3. Under Treat‐All only, the risk of the unfavourable outcome was higher for pregnant women, WHO III/IV clinical stage and elevated creatinine. Conclusions Compared to SOC, Treat‐All resulted in comparable retention, improved viral suppression and comparable composite outcomes of retention without viral failure.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 68%

Section: Explanation Of Findingsmentioning

confidence: 65%

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HIV programmatic outcomes following implementation of the ‘Treat‐All’ policy in a public sector setting in Eswatini: a prospective cohort study

et al. 2020

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“…Systematic reviews of health services that predict adult retention in HIV care in low‐resource settings have identified factors of ART counselling at initiation, lower staff workload in the clinic, community‐based service delivery, down‐referral of stable patients and differentiated care. It is noted, however, that none of these factors had been shown to be effective amongst adolescents .…”

Section: Introductionmentioning

confidence: 99%

STACKing the odds for adolescent survival: health service factors associated with full retention in care and adherence amongst adolescents living with HIV in South Africa

et al. 2018

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IntroductionThere are two million HIV‐positive adolescents in southern Africa, and this group has low retention in care and high mortality. There is almost no evidence to identify which healthcare factors can improve adolescent self‐reported retention. This study examines factors associated with retention amongst antiretroviral therapy (ART)‐initiated adolescents in South Africa.MethodsWe collected clinical records and detailed standardized interviews (n = 1059) with all 10‐ to 19 year‐olds ever initiated on ART in all 53 government clinics of a health subdistrict, and community traced to include lost‐to‐follow‐up (90.1% of eligible adolescents interviewed). Associations between full self‐reported retention in care (no past‐year missed appointments and 85% past‐week adherence) and health service factors were tested simultaneously in sequential multivariate regression and marginal effects modelling, controlling for covariates of age, gender, urban/rural location, formal/informal housing, maternal and paternal orphanhood, vertical/horizontal HIV infection, overall health, length of time on ART and type of healthcare facility.ResultsAbout 56% of adolescents had self‐reported retention in care, validated against lower detectable viral load (AOR: 0.63, CI: 0.45 to 0.87, p = 0.005). Independent of covariates, five factors (STACK) were associated with improved retention: clinics Stocked with medication (OR: 3.0, CI: 1.6 to 5.5); staff with Time for adolescents (OR: 2.7, CI: 1.8 to 4.1); adolescents Accompanied to the clinic (OR: 2.3, CI: 1.5 to 3.6); enough Cash to get to clinic safely (OR: 1.4, CI: 1.1 to 1.9); and staff who are Kind (OR: 2.6, CI: 1.8 to 3.6). With none of these factors, 3.3% of adolescents reported retention. With all five factors, 69.5% reported retention.ConclusionsThis study identifies key intervention points for adolescent retention in HIV care. A basic package of clinic and community services has the potential to STACK the odds for health and survival for HIV‐positive adolescents.

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“…PLHIV on ART who are not retained in care are at increased risk of developing drug resistance and dying [4]. 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].…”

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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Predictors of Adult Retention in HIV Care: A Systematic Review

Cited by 106 publications

References 38 publications

HIV programmatic outcomes following implementation of the ‘Treat‐All’ policy in a public sector setting in Eswatini: a prospective cohort study

HIV programmatic outcomes following implementation of the ‘Treat‐All’ policy in a public sector setting in Eswatini: a prospective cohort study

STACKing the odds for adolescent survival: health service factors associated with full retention in care and adherence amongst adolescents living with HIV in South Africa

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

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