Retention in Care among HIV-Infected Patients in Resource-Limited Settings: Emerging Insights and New Directions

Abstract

In resource-limited settings-where a massive scale up of HIV services has occurred in the last 5 years-both understanding the extent of and improving retention in care presents special challenges. First, retention in care within the decentralizing network of services is likely higher than existing estimates that account only for retention in clinic, and therefore antiretroviral therapy services may be more effective than currently believed. Second, both magnitude and determinants of patient retention vary substantially and therefore encouraging the conduct of locally relevant epidemiology is needed to inform programmatic decisions. Third, socio-structural factors such as program characteristics, transportation, poverty, work/child care responsibilities, and social relations are the major determinants of retention in care, and therefore interventions to improve retention in care should focus on implementation strategies. Research to assess and improve retention in care for HIV-infected patients can be strengthened by incorporating novel methods such as sampling-based approaches and a causal analytic framework.

Bridging barriers to clinic-based HIV testing with new technology: translating self-implemented testing for African American youth

“…Program fit is consistently identified as important to successful program implementation [47] and represents a potential point of intervention in efforts to increase program fidelity. Although a number of HIV prevention studies have shown that poor program-client fit by agencyimplemented programs results in low program fidelity [42,[48][49][50][51][52][53], none of this work has examined selfimplemented programs.…”

Provision of Antiretroviral Therapy in South Africa: The Nuts and Bolts

“…Decentralizing ART Benefits of decentralization of patient care include improved retention rates among adults and children compared with centralized hospital services and enabling better coverage of services [92][93][94][95][96].…”

Care Management: Perspectives from Managers, Professionals and Users of a Specialized Service Facility Focused on Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome

“…This reorganization is justified primarily by the promising results reported in the literature for PLWHA who are monitored in a primary care setting [18] and by evidence that centralization of HIV/AIDS services and minimizing the distance between the homes of PLWHA and health facilities are factors that affect the likelihood that PLWHA will follow treatment protocols [19][20][21].…”